title: Association between non-adherence to statin and hospitalization for cardiovascular disease and all-cause mortality in a national cohort.
abstract: OBJECTIVE
  This study evaluates the effect of adherence to stain on hospitalization for cardiovascular disease and all-cause mortality in South Korea.
  
  
  METHODS
  We performed a national cohort study on 423,786 individuals using the Korean National Health Insurance Claims Database. The cohort was composed of individuals who were aged between 18 and 84 years, were newly treated with statin, and were followed from 2005 to 2009. Adherence to statin was calculated using medication possession ratio (MPR) and associations between adherence to statin and health outcomes were evaluated using Cox's proportional hazards regression analysis.
  
  
  RESULTS
  Of the study subjects, 41.9% were male, 7.4% were beneficiaries of a tax-financed medical aid program (MAP), 1.5% had prior cardiovascular disease (CVD), 13.0% had diabetes, and 27.5% had hypertension. Non-adherence to statin was found to be associated with an increased risk of cardiovascular hospitalization (HR 2.18, 95% CI: 2.02 - 2.35) and all-cause mortality (HR = 1.75, CI: 1.66 - 1.84). As the age of the study group increased, non-adherence was more strongly associated with the risk of hospitalization for CVD. In addition, the risk of hospitalization for CVD was relatively high in patients who were male, older or MAP beneficiaries, and who had hypertension, diabetes, and high Charlson's comorbidity index.
  
  
  CONCLUSIONS
  This study supports that non-adherence to statin is associated with an elevated risk of hospitalization for cardiovascular disease and all-cause mortality.
authors.forename: Sukyoun
authors.initials: S
authors.lastname: Shin
authors.forename: Sunmee
authors.initials: S
authors.lastname: Jang
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Lee
authors.forename: Ho
authors.initials: H
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016016:Proportional Hazards Models
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors