title: Incidence of cardiovascular events in Italian patients with early discontinuations of antihypertensive, lipid-lowering, and antidiabetic treatments.
abstract: BACKGROUND
  Aim of the present investigation was to quantify the early discontinuation phenomenon in patients treated for hypertension, dyslipidemia or diabetes, and to assess their clinical characteristics and incidence of cardiovascular (CV) outcomes to see whether an incorrect diagnosis was involved or treatment continuation might have been indicated.
  
  
  METHODS
  Using the health-care databases on beneficiaries of the National Health Service (NHS) living in Lombardy, we studied patients aged 40-79 years who received their first prescription during 2003. Patients were classified according to whether they received only one or multiple prescriptions and data were compared with those obtained in individuals who did not receive any prescription. Crude and standardized rates of hospitalization for CV outcomes were calculated from initial prescription until 2008.
  
  
  RESULTS
  Among the 203,302 patients on antihypertensive therapy, those experiencing only one prescription (35.7%) showed significant higher rates of cotreatments, comorbidities, and CV hospitalization than those who did not receive antihypertensive medications. Standardized CV rates were respectively 40.0 and 37.8 events every 10,000 person-year at risk (+7%). Similar findings were obtained for antidiabetic or lipid-lowering medications for which the between-group difference in CV rate was even greater (+21% and +18% respectively).
  
  
  CONCLUSIONS
  In general practice management of hypertension, dyslipidemia and diabetes is characterized by a high rate of treatment discontinuation. Patients who early discontinued had an unfavorable risk profile and a greater incidence of CV events than untreated patients. This suggests that they include candidates in whom treatment continuation is advisable.
authors.affiliation: Department of Statistics, Unit of Biostatistics and Epidemiology, University of Milano-Bicocca, Milan, Italy. giovanni.corrao@unimib.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
authors.forename: Antonella
authors.initials: A
authors.lastname: Zambon
authors.forename: Andrea
authors.initials: A
authors.lastname: Parodi
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000188:drug therapy; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D028761:Withholding Treatment
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents