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REFLECTIONS                                                                                                                          dae mia
Dyslipidaemia Global Newsletter #3                                                                                                   Dyslipi
                                                                                                                                     Dyslipi
Associations of categories of statin adherence, Intensity, and adherence-adjusted intensity with                                     aim ead
the risk of MACE and with the attainment of LDL-C goal of <1.8 mmol/L (70 mg/dL).

Category?                                      Risk of suffering MACE, ?  Odds of reaching LDL-C goals, ?
Statin adherence?                                     aHR (95% CI)?                   OR (95% CI)?

  Adherence, PDC =80%?                                    REF                            REF
  Poorly adherent?                                1.23 (1.12–1.34)?              0.67 (0.60–0.75)?
  Discontinued =1 year?                           1.66 (1.23–2.22)?              0.20 (0.13–0.30)?
Statin intensity?
  High intensity, =50% LDL reduction?                     REF?                           REF?
  Low-moderate intensity, <50% LDL reduction?     1.00 (0.92–1.08)?              0.71 (0.64–0.78)?
  Discontinued =1 year?                           1.57 (1.17–2.10)?              0.14 (0.09–0.21)?
Combined adherence and treatment intensity?
  High intensity, adherent?                               REF?                           REF?
  Low-moderate intensity, adherent?               0.96 (0.88–1.05)?              0.70 (0.63–0.79)?
  Low-moderate, poorly adherent?                  1.32 (1.17–1.48)?              0.54 (0.45–0.64)?
  High intensity, poorly adherent                 1.16 (1.01–1.33)?              0.69 (0.61–0.79)?

Adherent patients are those with a proportion of days covered of 80% or higher for the year.
aHR, adjusted hazard ratio; CI, confidence interval; LDL, low-density lipoprotein; OR, odds ratio; PDC, proportion of days covered.

Good adherence appeared to be more important with respect to MACE, than treatment intensity, with robust results across sensitivity
analyses, subgroups, and secondary outcomes. Subgroup analyses included age, sex, CHD type (revascularization vs. acute MI),
diabetes, eGFR =60 mL/min/1.73 m2, history of previous CHD, and baseline LDL-C =3.5 mmol/L.

Each 10% increase in adherence, intensity, or the product term of adherence and intensity, was associated with higher odds of
LDL-C goal attainment.

This study demonstrated that in routine care, good adherence to LLT was associated with the greatest benefit for patients with
coronary heart disease. Strategies that improve adherence and use of intensive therapies could reduce cardiovascular risk in real-
world practice.

READ A COMMENTARY ON THE                       The effect of adherence (y axis, %) on the predicted probability of LDL-C
ARTICLE FROM THE LEAD AUTHOR                      goal attainment across levels of intensity (x-axis, %) and vice versa

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