title: Is high-intensity statin therapy associated with lower statin adherence compared with low- to moderate-intensity statin therapy? Implications of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guidelines.
abstract: BACKGROUND
  The recent cholesterol guideline recommends high-intensity statins in cardiovascular disease (CVD) patients. High-intensity statins are associated with more frequent side effects. Therefore, it may be of concern that these recommendations might reduce statin adherence.
  
  
  OBJECTIVE
  High-intensity statins are associated with lower adherence compared with low- to moderate-intensity statins.
  
  
  METHODS
  In a national database of 972,532 CVD patients from the Veterans Health Administration, we identified patients receiving statins between October 1, 2010, and September 30, 2011. We assessed statin adherence by calculating proportion of days covered (PDC) and determined whether high-intensity statin therapy was independently associated with a lower PDC.
  
  
  RESULTS
  Statins were prescribed in 629,005 (64.7%). Of those, 229,437 (36.5%) received high-intensity statins. Mean PDC (0.87 vs 0.86, P < 0.0001) and patients with PDC ≥ 0.80 (76.3% vs 74.2%, P < 0.0001) were slightly higher for those receiving low- to moderate-intensity compared with high-intensity statins. In adjusted analyses, high-intensity statin use was associated with a significant but modest PDC reduction compared with low- to moderate-intensity statin use, whether PDC was assessed as a continuous (β-coefficient: -0.008, P < 0.0001) or categorical (PDC ≥ 0.80 [odds ratio: 0.94, 95% confidence interval: 0.93-0.96]) measure of statin adherence.
  
  
  CONCLUSIONS
  An approach of high-intensity statin therapy will lead to a significant practice change, as the majority of CVD patients are not on high-intensity therapy. However, this change may be associated with a very modest reduction in statin adherence compared with low- to moderate-intensity therapy that is unlikely to be of clinical significance.
authors.affiliation: Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Baylor College of Medicine, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houstona, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: LeChauncy D
authors.initials: LD
authors.lastname: Woodard
authors.forename: Julia M
authors.initials: JM
authors.lastname: Akeroyd
authors.forename: David J
authors.initials: DJ
authors.lastname: Ramsey
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
mesh_terms: D000367:Age Factors; D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000188:drug therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D044469:Racial Groups; D012737:Sex Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D016903:Drug Monitoring
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors