title: Statin adherence and the risk of major coronary events in patients with diabetes: a nested case-control study.
abstract: OBJECTIVE
  To evaluate whether good statin adherence is associated with a reduced incidence of major coronary events (MCEs) among diabetic patients with and without coronary heart disease (CHD).
  
  
  METHODS
  Using data derived by linkage of nationwide health databases in Finland, we conducted a nested case-control analysis of 3513 cases with an MCE, a composite of acute myocardial infarction and/or coronary revascularization, and 20,090 matched controls identified from a cohort of 60,677 statin initiators with diabetes. Cases and controls were matched according to gender, time of cohort entry and duration of follow-up and further classified to two risk groups according to the presence of CHD at statin initiation. The incidence of MCEs was compared between patients with good statin adherence (the proportion of days covered ≥80%) and patients with poor statin adherence (<80%). Odds ratios (OR) for MCEs were estimated by conditional logistic regression adjusting for several covariables.
  
  
  RESULTS
  Good statin adherence was associated with a reduced incidence of MCEs in those with prior CHD [OR 0.84 (95% CI 0.74-0.95)] and in those without it [OR 0.86 (95% CI 0.78-0.95)]. The association persisted among those followed up for 5 years or longer [OR 0.77 (95% CI 0.58-1.02) and OR 0.79 (95% CI 0.66-0.94) respectively]. In sensitivity analyses, a reduced MCE incidence was observed also in those without any documented cardiovascular disease (CVD) at statin initiation [OR 0.87 (95% CI 0.78-0.96) overall and OR 0.80 (95% CI 0.66-0.97) for those followed up 5 years or longer].
  
  
  CONCLUSIONS
  In patients with diabetes, good adherence to statins predicts reduced incidence of MCEs irrespective of the presence of CHD at statin initiation.
authors.affiliation: Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Ruokoniemi
authors.forename: Maarit J
authors.initials: MJ
authors.lastname: Korhonen
authors.forename: Arja
authors.initials: A
authors.lastname: Helin-Salmivaara
authors.forename: Piia
authors.initials: P
authors.lastname: Lavikainen
authors.forename: Antti
authors.initials: A
authors.lastname: Jula
authors.forename: Seppo Y T
authors.initials: SY
authors.lastname: Junnila
authors.forename: Raimo
authors.initials: R
authors.lastname: Kettunen
authors.forename: Risto
authors.initials: R
authors.lastname: Huupponen
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage; D016022:Case-Control Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors