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Influence of baseline low-density lipoprotein cholesterol values on statin therapy persistence

European Journal of Clinical Pharmacology volume 72, pages 349–357 (2016)Cite this article

Abstract

Purpose

Persistence to statins is low, in part due to lack of perception of cardiovascular (CV) risk. High values of low-density lipoprotein cholesterol (LDL-C) might increase the motivation for patients to be persistent. We investigated whether the baseline LDL-C value influences the discontinuation of statin treatment in patients with and without previous CV events.

Methods

A cohort study was performed using information from the Swedish national registers concerning dispensed drugs, hospital contacts, cause of death, and socioeconomic status, and linked with data from clinical laboratories. Incident statin users 20 years of age or older and starting treatment between 2006 and 2007 were identified and followed for 1 year. Baseline LDL-C level was defined as the last available laboratory test result during 6 months before the index statin dispensing. Cox regression was used to study discontinuation and estimate the effect on persistence of the baseline LDL-C value adjusting for sex, age, income, comorbidity, previous CV events, type of prescriber, and country of birth. Subgroup analyses stratifying by previous CV events and by diagnosis of diabetes among subjects without previous CV events were performed.

Results

A total of 29,389 patients were identified; 35.4 % had a previous CV event. A high baseline LDL-C value was associated with a lower discontinuation rate (hazard ratio (HR) 0.81, 95 % confidence interval (CI) 0.72–0.91) in patients without previous CV events. When stratifying further by diabetes diagnosis, the association was confirmed only in patients without diabetes. No association between LDL-C and persistence was found in patients with previous CV events.

Conclusions

High levels of LDL-C were positively associated with statin persistence in newly treated diabetes patients without previous CV events.

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Authors’ Contributions

AC was responsible for study design, analysis, interpretation of data, drafting the article.

HK contributed to the conception and study design and interpretation of data and reviewed the manuscript critically for important intellectual content.

ML contributed for statistical data analysis and interpretation of data and reviewed the manuscript critically for important intellectual content.

AS contributed to the conception and study design, and the interpretation of data.

BW contributed to interpretation of data and reviewed the manuscript for important intellectual content.

IAB reviewed the manuscript critically for important intellectual content.

MA was responsible for conception and study design, analysis, interpretation of data, drafting the article, and study supervision.

All authors approved the final version of the manuscript.

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Affiliations

  1. Centre for Pharmacoepidemiology (CPE), Department of Medicine, Karolinska Institutet, Stockholm, SE-17176, Sweden

    Anna Citarella, Marie Linder, Helle Kieler, Ingegärd Anveden Berglind, Anders Sundström, Björn Wettermark & Morten Andersen

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  1. Anna Citarella
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  2. Marie Linder
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  3. Helle Kieler
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Correspondence to Anna Citarella.

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Funding

The study was supported by research funding from AstraZeneca, Merck, and Pfizer. The funders had no role in the data collection and analysis and were not involved in the interpretation of results, writing, and approval of the manuscript.

Conflict of interest

The authors are employed or affiliated at Centre for Pharmacoepidemiology, which receives grants from several entities (pharmaceutical companies, regulatory authorities, and contract research organizations) for performance of drug safety and drug utilization studies.

BW is board member at Regional Drug and Therapeutic committee and expert group of cardiovascular disease.

MA received fees for leading and teaching pharmacoepidemiology courses at Medicademy, the Danish Association for the Pharmaceutical Industry.

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Citarella, A., Linder, M., Kieler, H. et al. Influence of baseline low-density lipoprotein cholesterol values on statin therapy persistence. Eur J Clin Pharmacol 72, 349–357 (2016). https://doi.org/10.1007/s00228-015-1996-7

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  • DOI: https://doi.org/10.1007/s00228-015-1996-7

Keywords

  • Persistence
  • Statin
  • Therapy discontinuation
  • Pharmacoepidemiology
  • Lipid values