title: Association between statin adherence and cholesterol level reduction from baseline in a veteran population.
abstract: OBJECTIVE
  To investigate the association between statin adherence and changes in lipid panel outcomes from baseline in a veteran population.
  
  
  METHODS
  Retrospective cohort study using multiple linear regression models.
  
  
  METHODS
  Veterans Affairs health care system within the Veterans Integrated Service Network 22, a network of Veterans Affairs facilities in the southwest region of the United States that includes Los Angeles, San Diego, Loma Linda, and Long Beach, California, and Las Vegas, Nevada, with an enrollment of approximately 1.4 million veterans.
  
  
  METHODS
  A total of 5365 patients who were new statin users between December 1, 2006, and November 30, 2007; 2674 patients were in the adherent group and 2691 were in the nonadherent group.
  
  
  RESULTS
  Adherence was determined by the medication possession ratio. Patients were categorized as adherent if the medication possession ratio at follow-up was 0.80 or more. Adherent patients exhibited significant differences in baseline demographic and clinical characteristics than nonadherent patients in our study sample. Baseline laboratory values for adherent patients were significantly lower for low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), non-high-density lipoprotein cholesterol (non-HDL), and total cholesterol levels. The primary outcome was change in LDL level from baseline at 12 months. Secondary outcomes were changes in non-HDL and total cholesterol levels from baseline at 12 months. Independent variables controlled for in the multiple linear regression included age, sex, body mass index, race-ethnicity, baseline lipid panel (LDL, HDL, total cholesterol, and triglycerides), statin copayment status, income quintile (according to ZIP code median household income), baseline medication count, statin prescribed, and comorbidities. Multiple linear regression revealed that adherent patients demonstrated significantly greater reductions in LDL of 20.98 mg/dl versus nonadherent patients (p<0.0001). Adherent patients similarly demonstrated larger reductions of 24.31 mg/dl in non-HDL and 24.06 mg/dl in total cholesterol versus nonadherent patients (p<0.0001 for both comparisons).
  
  
  CONCLUSIONS
  Patients adherent to statin therapy had significant associations with clinically relevant reductions in LDL, non-HDL, and total cholesterol from baseline at 12 months compared with nonadherent patients when controlling for potential confounders. Adherence to statin therapy may have important consequences in decreasing clinical outcomes such as myocardial infarctions, strokes, and mortality due to large reductions in lipid panel outcomes from baseline at 12 months.
authors.affiliation: Pharmacoeconomics Section, Veterans Affairs San Diego Healthcare System, San Diego, California; UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California.
authors.forename: Rashid
authors.initials: R
authors.lastname: Kazerooni
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Watanabe
authors.forename: Mark
authors.initials: M
authors.lastname: Bounthavong
mesh_terms: D000368:Aged; D002140:California; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D016014:Linear Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009505:Nevada; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014728:Veterans
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: Veteran; adherence; compliance; low-density lipoprotein cholesterol; statin