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Switching, Persistence and Adherence to Statin Therapy: a Retrospective Cohort Study Using the Australian National Pharmacy Data

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Abstract

Background

Statins are widely prescribed for the primary and secondary prevention of cardiovascular disease (CVD), but their effectiveness is dependent on the level of adherence and persistence.

Objectives

This study aimed to explore the patterns of switching, adherence and persistence among the Australian general population with newly dispensed statins.

Methods

A retrospective cohort study was conducted using a random sample of data from the Australian national prescription claims data. Switching, adherence to and persistence with statins were assessed for people starting statins from 1 January 2015 to 31 December 2019. Switching was defined as either switching to another intensity of statin, to another statin or to a non-statin agent. Non-persistence to treatment was defined as discontinuation (i.e. ≥90 days with no statin) of coverage. Adherence was measured using proportion of days covered (PDC), and patients with PDC < 0.80 were considered non-adherent. Cox proportional hazard models were used to compare discontinuation, switching and reinitiation between different statins.

Results

A cohort of 141,062 people dispensed statins and followed over a median duration of 2.5 years were included. Of the cohort, 29.3% switched statin intensity, 28.4% switched statin type, 3.7% switched to ezetimibe and in 2.7%, ezetimibe was added as combination therapy during the study period. Overall, 58.8% discontinued statins based on the 90-day gap criteria, of whom 55.2% restarted. The proportion of people non-adherent was 24.0% at 6 months to 49.0% at 5 years. People on low and moderate intensity statins were more likely to discontinue compared to those on high-intensity statins (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.31), (HR 1.28, 95%CI 1.14–1.42), respectively. Compared to maintaining same statin type and intensity, switching statins, which includes up-titration (HR 0.77, 95%CI 0.70 to 0.86) was associated with less likelihood of discontinuation after reinitiation.

Conclusions

Long-term persistence and adherence to statins remains generally poor among Australians, which limits the effectiveness of these medicines and the consequent health impact they may provide for individuals (and by extension, the population impact when poor persistence and adherence is considered in the statin-taking population). Switching between statins is prevalent in one third of statin users, although any clinical benefit of the observed switching trend is unknown. This, combined with the high volume of statin prescriptions, highlights the need for better strategies to address poor persistence and adherence.

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Abbreviations

CVD:

Cardiovascular disease

PBS:

Pharmaceutical Benefits Scheme

LDL-C:

Low-density lipoprotein cholesterol

PCSK9:

Proprotein convertase subtilisin/kexin type 9

PDC:

Proportion of days covered

GPs:

General practitioners

PBAC:

Pharmaceutical Benefits Advisory Committee

References

  1. World Health Organization. WHO cardiovascular diseases fact sheet providing key facts and information on risk factors, symptoms, rheumatic heart disease, treatment and prevention, WHO response. 2017. Available from: https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1.

  2. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159)1736–88.

  3. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982–3021.

    Article  PubMed  PubMed Central  Google Scholar 

  4. AIHW. Cardiovascular disease. Canberra: Australian Institute of Health and Welfare, 2020. https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/cardiovascular-health-compendium/contents/how-many-australians-have-cardiovascular-disease.

  5. Yusuf PS, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438)937–52.

  6. Abdullah SM, Defina LF, Leonard D, Barlow CE, Radford NB, Willis BL, et al. Long-term association of low-density lipoprotein cholesterol with cardiovascular mortality in individuals at low 10-year risk of atherosclerotic cardiovascular disease: results from the Cooper Center longitudinal study. Circulation. 2018;138(21):2315–25.

    Article  CAS  PubMed  Google Scholar 

  7. Clinician guide to the ABCs of primary and secondary prevention of atherosclerotic cardiovascular disease. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2018/03/30/18/34/clinician-guide-to-the-abcs.

  8. Arnett DK, Roger Blumenthal C-CS, Michelle Albert C-CA, Buroker AB, Goldberger ZD, Hahn EJ, et al. Force on clinical practice guidelines. Circulation. 2019;140:563–95.

    Google Scholar 

  9. MacMahon S, Duffy S, Rodgers A, Tominaga S, Chambless L, De Backer G, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: A meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007;370(9602):1829–39.

  10. Newman CB, Preiss D, Tobert JA, Jacobson TA, Page RL, Goldstein LB, et al. Statin safety and associated adverse events a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2019;39(2):E38–81.

    Article  CAS  PubMed  Google Scholar 

  11. Rosenson RS, Baker S, Banach M, Borow KM, Braun LT, Bruckert E, et al. Optimizing cholesterol treatment in patients with muscle complaints. J Am Coll Cardiol. 2017;70(10):1290–301.

    Article  PubMed  Google Scholar 

  12. Mantel-Teeuwisse AK, Goettsch WG, Klungel OH, De Boer A, Herings RMC. Long term persistence with statin treatment in daily medical practice. Heart. 2004;90(9):1065–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Toth PP, Granowitz C, Hull M, Anderson A, Philip S. Long-term statin persistence is poor among high-risk patients with dyslipidemia: a real-world administrative claims analysis. Lipids Health Dis. 2019;18(1):175.

  14. Wei MY, Ito MK, Cohen JD, Brinton EA, Jacobson TA. Predictors of statin adherence, switching, and discontinuation in the USAGE survey: understanding the use of statins in America and gaps in patient education. J Clin Lipidol. 2013;7(5):472–83.

  15. Ho K, Jamsen KM, Bell JS, Korhonen MJ, Mc Namara KP, Magliano DJ, et al. Demographic, clinical and lifestyle factors associated with high-intensity statin therapy in Australia: the AusDiab study. Eur J Clin Pharmacol. 2018;74(11):1493–501.

    Article  CAS  PubMed  Google Scholar 

  16. Ofori-Asenso R, Ilomaki J, Tacey M, Zomer E, Curtis AJ, Si S, et al. Switching, discontinuation, and reinitiation of statins among older adults. J Am Coll Cardiol. 2018;72(21):2675–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ofori-Asenso R, Ilomaki J, Tacey M, Zomer E, Curtis AJ, Bell JS, et al. Patterns of statin use and long-term adherence and persistence among older adults with diabetes. J Diabetes. 2018;10(9):699–707.

    Article  CAS  PubMed  Google Scholar 

  18. Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother. 2010;44(9):1410–21.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mellish L, Karanges EA, Litchfield MJ, Schaffer AL, Blanch B, Daniels BJ, et al. The Australian pharmaceutical benefits scheme data collection: a practical guide for researchers. BMC Res Notes. 2015;8:634.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129(25 Suppl 2):S1–45.

    PubMed  Google Scholar 

  21. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.

    Article  PubMed  Google Scholar 

  22. Ofori-Asenso R, Ilomaki J, Zomer E, Curtis AJ, Zoungas S, Liew D. A 10-year trend in statin use among older adults in Australia: an analysis using national pharmacy claims data. Cardiovasc Drugs Ther. 2018;32(3):265–72.

    Article  PubMed  Google Scholar 

  23. Simons LA, Ortiz M, Calcino G. Long term persistence with statin therapy -- experience in Australia 2006-2010. Aust Fam Physician. 2011;40(5):319–22.

    PubMed  Google Scholar 

  24. Ofori-Asenso R, Zoungas S, Liew D. Reinitiation of statin therapy after discontinuation: a meta-analysis. Mayo Clin Proc. 2018;93(5):666–8.

    Article  PubMed  Google Scholar 

  25. Ofori-Asenso R, Jakhu A, Zomer E, Curtis AJ, Korhonen MJ, Nelson M, et al. Adherence and persistence among statin users aged 65 years and over: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2018;73(6):813–9.

    Article  PubMed  Google Scholar 

  26. Booth JN, Colantonio LD, Chen L, Rosenson RS, Monda KL, Safford MM, et al. Statin discontinuation, Reinitiation, and persistence patterns among Medicare beneficiaries after myocardial infarction. Circ Cardiovasc Quality Outcomes. 2017;10(10):e003626.

    Article  Google Scholar 

  27. Vinogradova Y, Coupland C, Brindle P, Hippisley-Cox J. Discontinuation and restarting in patients on statin treatment: prospective open cohort study using a primary care database. BMJ. 2016;353:i3305.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Andrade SE, Walker AM, Gottlieb LK, Hollenberg NK, Testa MA, Saperia GM, et al. Discontinuation of antihyperlipidemic drugs--do rates reported in clinical trials reflect rates in primary care settings? N Engl J Med. 1995;332(17):1125–31.

    Article  CAS  PubMed  Google Scholar 

  29. Chodick G, Shalev V, Gerber Y, Heymann AD, Silber H, Simah V, et al. Long-term persistence with statin treatment in a not-for-profit health maintenance organization: a population-based retrospective cohort study in Israel. Clin Ther. 2008;30(11):2167–79.

    Article  PubMed  Google Scholar 

  30. Chew DP, Scott IA, Cullen L, French JK, Briffa TG, Tideman PA, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Med J Aust. 2016;205(3):128–33.

    Article  PubMed  Google Scholar 

  31. Ridker PM, Mora S, Rose L, Group JTS. Percent reduction in LDL cholesterol following high-intensity statin therapy: potential implications for guidelines and for the prescription of emerging lipid-lowering agents. Eur Heart J. 2016;37(17):1373–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Qi K, Reeve E, Hilmer SN, Pearson SA, Matthews S, Gnjidic D. Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Clin Pharm. 2015;37(5):949–57.

    Article  PubMed  Google Scholar 

  33. Schiattarella GG, Perrino C, Magliulo F, Ilardi F, Serino F, Trimarco V, et al. Statins and the elderly: recent evidence and current indications. Aging Clin Exp Res. 2012;24(3 Suppl):47–55.

    PubMed  Google Scholar 

  34. Navarese EP, Robinson JG, Kowalewski M, Kołodziejczak M, Andreotti F, Bliden K, et al. Association between baseline LDL-C level and Total and cardiovascular mortality after LDL-C lowering: a systematic review and meta-analysis. JAMA. 2018;319(15):1566–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166(17):1842–7.

    Article  PubMed  Google Scholar 

  36. Herttua K, Martikainen P, Batty GD, Kivimaki M. Poor adherence to statin and antihypertensive therapies as risk factors for fatal stroke. J Am Coll Cardiol. 2016;67(13):1507–15.

    Article  PubMed  PubMed Central  Google Scholar 

  37. De Vera MA, Bhole V, Burns LC, Lacaille D. Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review. Br J Clin Pharmacol. 2014;78(4):684–98.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Yan AT, Yan RT, Tan M, Hackam DG, Leblanc KL, Kertland H, et al. Contemporary management of dyslipidemia in high-risk patients: targets still not met. Am J Med. 2006;119(8):676–83.

    Article  PubMed  Google Scholar 

  39. Vonbank A, Saely CH, Rein P, Sturn D, Drexel H. Current cholesterol guidelines and clinical reality: a comparison of two cohorts of coronary artery disease patients. Swiss Med Wkly. 2013;143:w13828.

    PubMed  Google Scholar 

  40. Vonbank A, Agewall S, Kjeldsen KP, Lewis BS, Torp-Pedersen C, Ceconi C, et al. Comprehensive efforts to increase adherence to statin therapy. Eur Heart J. 2017;38(32):2473–9.

    PubMed  Google Scholar 

  41. Giugliano RP, Cannon CP, Blazing MA, Nicolau JC, Corbalan R, Spinar J, et al. Benefit of adding ezetimibe to statin therapy on cardiovascular outcomes and safety in patients with versus without diabetes mellitus: results from IMPROVE-IT (improved reduction of outcomes: Vytorin efficacy international trial). Circulation. 2018;137(15):1571–82.

    Article  CAS  PubMed  Google Scholar 

  42. Koskinas KC, Siontis GCM, Piccolo R, Mavridis D, Raber L, Mach F, et al. Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials. Eur Heart J. 2018;39(14):1172–80.

    Article  CAS  PubMed  Google Scholar 

  43. Vavlukis M, Vavlukis A. Adding ezetimibe to statin therapy: latest evidence and clinical implications. Drugs Context. 2018;7:212534.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Yu M, Liang C, Kong Q, Wang Y, Li M. Efficacy of combination therapy with ezetimibe and statins versus a double dose of statin monotherapy in participants with hypercholesterolemia: a meta-analysis of literature. Lipids Health Dis. 2020;19(1):1.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fung V, Graetz I, Reed M, Jaffe MG. Patient-reported adherence to statin therapy, barriers to adherence, and perceptions of cardiovascular risk. PLoS One. 2018;13(2):e0191817-e.

    Article  Google Scholar 

  46. Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Fam Pract. 2019;20(1):132.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Rafii F, Fatemi NS, Danielson E, Johansson CM, Modanloo M. Compliance to treatment in patients with chronic illness: a concept exploration. Iran J Nurs Midwifery Res. 2014;19(2):159–67.

    PubMed  PubMed Central  Google Scholar 

  48. Penson PE, Mancini GBJ, Toth PP, Martin SS, Watts GF, Sahebkar A, et al. Introducing the ‘Drucebo’ effect in statin therapy: a systematic review of studies comparing reported rates of statin-associated muscle symptoms, under blinded and open-label conditions. J Cachexia Sarcopenia Muscle. 2018;9(6):1023–33.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Nct. Self-Assessment Method for Statin Side-effects Or Nocebo. 2016. https://www.clinicaltrials.gov/ct2/show/NCT02668016.

  50. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.

    Article  PubMed  Google Scholar 

  51. Grabowski DC, Lakdawalla DN, Goldman DP, Eber M, Liu LZ, Abdelgawad T, et al. The large social value resulting from use of statins warrants steps to improve adherence and broaden treatment. Health Aff. 2012;31(10):2276–85.

    Article  Google Scholar 

  52. Matthews A, Herrett E, Gasparrini A, Van Staa T, Goldacre B, Smeeth L, et al. Impact of statin related media coverage on use of statins: interrupted time series analysis with UK primary care data. BMJ. 2016;353:i3283.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Andrade AQ, Roughead EE. Consumer-directed technologies to improve medication management and safety. Med J Aust. 2019;210(Suppl 6):S24–S7.

    PubMed  Google Scholar 

  54. Karatasakis A, Danek BA, Karacsonyi J, Rangan BV, Roesle MK, Knickelbine T, et al. Effect of PCSK9 inhibitors on clinical outcomes in patients with hypercholesterolemia: a meta-analysis of 35 randomized controlled trials. J Am Heart Assoc. 2017;6(12):e006910.

  55. Krahenbuhl S, Pavik-Mezzour I, von Eckardstein A. Unmet needs in LDL-C lowering: when statins won’t do! Drugs. 2016;76(12):1175–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Marquina C, Zomer E, Vargas-Torres S, Zoungas S, Ofori-Asenso R, Liew D, et al. Novel treatment strategies for secondary prevention of cardiovascular disease: a systematic review of cost-effectiveness. Pharmacoeconomics. 2020;38(10):1095–113.

    Article  PubMed  Google Scholar 

  57. Nissen SE, Stroes E, Dent-Acosta RE, Rosenson RS, Lehman SJ, Sattar N, et al. Efficacy and tolerability of Evolocumab vs ezetimibe in patients with muscle-related statin intolerance: the GAUSS-3 randomized clinical trial. JAMA. 2016;315(15):1580–90.

    Article  CAS  PubMed  Google Scholar 

  58. Cardoso R, Blumenthal RS, Kopecky S, Lopez-Jimenez F, Martin SS. How low to go with lipid-lowering therapies in a cost-effective and prudent manner. Mayo Clin Proc. 2019;94(4):660–9.

    Article  PubMed  Google Scholar 

  59. Korman M, Wisløff T. Modelling the cost-effectiveness of PCSK9 inhibitors vs. ezetimibe through LDL-C reductions in a Norwegian setting. Eur Heart J Cardiovasc Pharmacother. 2018;4(1):15–22.

    Article  PubMed  Google Scholar 

  60. Ference BA, Yoo W, Alesh I, Mahajan N, Mirowska KK, Mewada A, et al. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. J Am Coll Cardiol. 2012;60(25):2631–9.

    Article  CAS  PubMed  Google Scholar 

  61. Bhatt DL, Briggs AH, Reed SD, Annemans L, Szarek M, Bittner VA, et al. Cost-effectiveness of alirocumab in patients with acute coronary syndromes. The Odyssey Outcomes Trial. 2020;75(18):2297–308.

    CAS  Google Scholar 

  62. Cybulska B, Kłosiewicz-Latoszek L, Penson PE, Nabavi SM, Lavie CJ, Banach M. How much should LDL cholesterol be lowered in secondary prevention? Clinical efficacy and safety in the era of PCSK9 inhibitors. Prog Cardiovasc Dis. 2020;S0033-0620(20):30210-3.

  63. Penson PE, Pirro M, Banach M. LDL-C: lower is better for longer—even at low risk. BMC Med. 2020;18(1):320.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Availability of Data and Material

Data are accessible or available upon request.

Funding

Amgen Australia Pty Ltd. has provided financial support to Monash University for analyses that describe the current burden and treatment of CVD in Australia, of which this manuscript forms a part.

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Authors and Affiliations

  1. School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia

    Stella Talic, Clara Marquina, Richard Ofori-Asenso, Marjana Petrova, Danny Liew, Alice J. Owen, Ella Zomer & Zanfina Ademi

  2. Amgen Europe GmbH, Dammstrasse 23, 6300, Zug, Switzerland

    Sean Lybrand

  3. Amgen Australia Pty Ltd, Macquarie Park, NSW, 2113, Australia

    David Thomson

  4. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia

    Jenni Ilomaki

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  1. Stella Talic
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Contributions

ST conceptualized the study, performed the analysis, validated and cross-checked analysis outputs with assistance from ROA and wrote the initial draft of the manuscript; CM, AJO, JI, MP, EZ and DL contributed to writing of the manuscript; JI, DT, SL provided constructive feedback and expert advice; ROA provided statistical support and expert feedback. ZA contributed to writing of the manuscript and supervised the project.

Corresponding author

Correspondence to Zanfina Ademi.

Ethics declarations

ROA declares no conflict of interest. Authors ZA, EZ, ST, CM, MP, AO and DL have received research funding from Amgen Australia Pty Ltd. underlying this manuscript. JI has received funding from AstraZeneca, Amgen, Dementia Australia, National Breast Cancer Foundation and National Health and Medical Research Council. DT is employed by Amgen Australia Pty Ltd., and SL was employed by Amgen Australia Pty Ltd. at the time of development of the research and is now employed by Amgen Europe GmbH. EZ reports grant support from Amgen, AstraZeneca, Pfizer, and Shire, outside the submitted work. DL declares grants from Abbvie, Amgen, AstraZeneca, Bristol-Myers Squibb, Pfizer and Sanofi, and past participation in advisory boards and/or receipt of honoraria from Abbvie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Edwards Lifesciences, Novartis, Pfizer, Sanofi and Shire, outside the submitted work.

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Talic, S., Marquina, C., Ofori-Asenso, R. et al. Switching, Persistence and Adherence to Statin Therapy: a Retrospective Cohort Study Using the Australian National Pharmacy Data. Cardiovasc Drugs Ther 36, 867–877 (2022). https://doi.org/10.1007/s10557-021-07199-7

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