title: Ability of low antihypertensive medication adherence to predict statin discontinuation and low statin adherence in patients initiating treatment after a coronary event.
abstract: Low statin adherence and discontinuation of statins are common in patients with coronary heart disease. We hypothesized that low antihypertensive medication adherence would be associated with future statin discontinuation and low adherence in patients initiating statins. Using a 5% national sample of Medicare beneficiaries, we conducted a cohort study of Medicare beneficiaries initiating statins after hospitalization for acute myocardial infarction or coronary revascularization in 2007, 2008, and 2009. Antihypertensive medication adherence, defined using the average proportion of days covered across 5 classes during the 365 days before hospitalization, was categorized as ≥80% (high), 50% to <80% (medium), and <50% (low). Statin discontinuation was defined as failure to refill a statin within 365 days of hospital discharge, and low adherence was defined as proportion of days covered for statins <80%. In 2,695 Medicare beneficiaries who initiated statins after hospital discharge, 6.0%, 8.4%, and 14.5% with high, medium, and low antihypertensive medication adherence discontinued statins. After multivariable adjustment, the risk ratios (95% confidence interval) for statin discontinuation were 1.38 (0.98 to 1.95) and 2.41 (1.51 to 3.87) for beneficiaries with medium and low versus high antihypertensive medication adherence, respectively. In beneficiaries who did not discontinue statins, 36.2% had low statin adherence. Compared with high adherence, medium and low antihypertensive medication adherences were associated with multivariable adjusted risk ratios (95% confidence interval) for low statin adherence of 1.33 (1.14 to 1.55) and 1.62 (1.25 to 2.10), respectively. In conclusion, low antihypertensive medication adherence before initiating statins is associated with future statin discontinuation and low statin adherence.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: pmuntner@uab.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Delzell
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Shia T
authors.initials: ST
authors.lastname: Kent
authors.affiliation: Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Kilgore
authors.affiliation: Department of Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.affiliation: Division of Research, Kaiser Permanente Georgia, Atlanta, Georgia.
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.affiliation: Department of Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rosenson
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States; D028761:Withholding Treatment / Q000639:trends*
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors