Adherence to statin treatment following a myocardial infarction: an Italian population-based survey

Figures & data

Table 1 Participant characteristics by statin treatment during hospitalization

	Statin treatment during hospitalization, n (%)/mean ± SD		P<
	No 960(28.5)	Yes 2,409(71.5)
Age, years	67.3±13.1	61.6±12.6	0.001
Sex, male	600 (62.5)	1,733 (71.9)	0.001
Hospitalization for CV reasons in the previous yeara	352 (36.7)	926 (38.4)	NS
Presence of diabetesa,b	290 (30.2)	594 (24.7)	0.001
Presence of CKDa	110 (11.5)	154 (6.4)	0.001
Total cholesterol,c,d mg/dL	174.8±50.5	194.3±55.4	0.001
LDL-C,c,e mg/dL	107.4±40.6	124.3±45.7	0.001
LDL-C >100 mg/dL	396 (58.1)	1,395 (74.4)	0.001
LDL-C >70 mg/dL	590 (86.6)	1,698 (90.5)	0.01

Notes:

a As inferred from hospital discharge database;

b as inferred from preadmission prescription of specific drugs;

c as inferred from hospital case history;

d as inferred from 3,006 of 3,369 (89.2%) hospital case histories;

e as inferred from 2,558 of 3,369 (75.9%) hospital case histories.

Abbreviations: SD, standard deviation; CV, cardiovascular; NS, not significant; CKD, chronic kidney disease; LDL-C, low-density-lipoprotein cholesterol.

Table 2 Participant characteristics by statin prescription at discharge

	Statin prescription at hospital dischargea, n (%)/mean ± SD			P<
	Yes 2,150 (63.8)	No 833 (24.7)	Unknown 386 (11.5)
Age, years	61.2±12.5	67.3±13.0	65.7±12.6	0.001
Sex, male	1,541 (71.7)	510 (61.2)	282 (73.1)	0.001
Statin treatment during hospitalizationa	2,076 (96.6)	107 (12.8)	226 (58.5)	0.001
Total cholesterol,b mg/dL	193.1±57.5	175.2±50.0	194.1±49.6	0.001
LDL-C,c mg/dL	123.9±45.6	108.5±40.5	117.0±46.7	0.001
LDL-C >100 mg/dL	1,307 (74.1)	361 (59.9)	125 (65.1)	0.001
LDL-C >70 mg/dL	1,596 (90.5)	522 (86.7)	169 (88.0)	0.05

Notes:

a As inferred from hospital case history;

b as inferred from 3,006 of 3,369 (89.2%) hospital case histories;

c as inferred from 2,558 of 3,369 (75.9%) hospital case histories.

Abbreviations: SD, standard deviation; LDL-C, low-density-lipoprotein cholesterol.

Table 3 Relationship between statin prescription at hospital discharge and first statin prescription out of the hospital

Statin prescribed athospital discharge, n %	First statin prescribed at the beginning of follow-up, n %						Total
	Atorvastatin	Pravastatin	Rosuvastatin	Simvastatin	Other statinsa	No statins
Atorvastatin	786	13	20	63	5	52	939
	83.7	1.4	2.1	6.7	0.5	5.5	100
Pravastatin	24	196	5	14	1	15	255
	9.4	76.9	2.0	5.5	0.4	5.9	100
Rosuvastatin	3	1	33	6	0	1	44
	6.8	2.3	75.0	13.6		2.3	100
Simvastatin	39	22	10	786	3	43	903
	4.3	2.4	1.1	87.0	0.3	4.8	100
Other statins	2	0	0	0	7	0	9
	22.2				77.8		100
No statins	155	42	50	141	24	421	833
	18.6	5.0	6.0	16.9	2.9	50.5	100
Unknown	123	31	12	117	10	93	386
	31.9	8.0	3.1	30.3	2.6	24.1	100
Total, n	1,132	305	130	1,127	50	625	3,369

Notes:

a Pooled prescriptions of fluvastatin (32 patients), lovastatin (nine patients), and simvastatin + ezetimibe (nine patients).

Table 4 Relationship between cholesterol levels and first statin prescription out of the hospital

	Statin treatment in follow-up, n (%)/mean ± SD					P<
	Atorvastatin 1,132 (41.3)	Pravastatin 305 (11.1)	Rosuvastatin 130 (4.7)	Simvastatin 1,127 (41.1)	Other statins 50 (1.8)
Total cholesterol,a mg/dL	196.5±54.1	190.6±55.5	191.3±62.3	189.1±58.4	198.4±57.8	0.05
LDL-C,b mg/dL	125.4±45.0	122.8±47.1	120.0±46.6	120.6±46.2	129.6±51.6	NS
LDL-C ≥100 mg/dL	682 (72.5%)	202 (78.3%)	77 (76.2%)	597 (73.1%)	28 (71.8%)	NS
LDL-C ≥70 mg/dL	854 (90.8%)	237 (91.9%)	90 (89.1%)	730 (89.4%)	36 (92.3%)	NS

Notes:

a As inferred from 2,479 of 2,744 (90.3%) hospital case histories;

b as inferred from 2,156 of 2,744 (78.6%) hospital case histories.

Abbreviations: SD, standard deviation; LDL-C, low-density-lipoprotein cholesterol; NS, not significant.

Table 5 Participant characteristics by statin treatment at follow-up

	Statin treatment at follow-up, n (%)/mean ± SD		P<
	No 625 (18.6)	Yes 2,744 (81.4)
Age, years	70.7±13.2	61.5±12.8	0.001
Sex, male	352 (56.3)	1,981 (72.2)	0.001
Hospitalization for CV reasons in the previous yeara	261 (41.8)	1,017 (37.1)	0.05
Presence of diabetesa,b	191 (30.6)	693 (25.3)	0.01
Presence of CKDa	84 (13.6)	180 (6.6)	0.001
Statin treatment during hospitalizationc	177 (28.3)	2,232 (81.3)	0.001
Prescription of statins at discharged	111 (20.9)	2,039 (83.2)	0.001
Total cholesterol,e mg/dL	172.2±46.2	192.7±56.5	0.001
LDL-C,f mg/dL	103.8±36.8	122.8±45.7	0.001
LDL-C >100 mg/dL	206 (51.5)	1,588 (73.6)	0.001
LDL-C >70 mg/dL	339 (84.8)	1,949 (90.3)	0.001

Notes:

a As inferred from hospital discharge database;

b as inferred from preadmission prescription of specific drugs;

c as inferred from hospital case history;

d as inferred from 2,983 of 3,369 (88.5%) hospital case histories;

e as inferred from 3,006 of 3,369 (89.2%) hospital case histories;

f as inferred from 2,558 of 3,369 (75.9%) hospital case histories.

Abbreviations: SD, standard deviation; CV, cardiovascular; CKD, chronic kidney disease; LDL-C, low-density-lipoprotein cholesterol.

Table 6 Study participant characteristics by persistence of statin treatment at follow-up

	Statin treatment at follow-up, n (%)/mean ±SD		P<
	Occasional 115 (4.2)	Persistent 2,629 (95.8)
Age, years	67.8±12.4	61.2±12.2	0.001
Sex, male	69 (60.0)	1,912 (72.7)	0.01
Hospitalization for CV reasons in the previous yeara	44 (38.3)	973 (37.0)	NS
Presence of diabetesa,b	43 (37.4)	650 (24.7)	0.001
Presence of CKDa	17 (14.8)	163 (6.2)	0.001
Statin treatment during hospitalizationc	65 (56.5)	2,167 (82.4)	0.001
Prescription of statins at discharged	51 (52.0)	1,988 (84.5)	0.001
Total cholesterol,e mg/dL	185.0±49.7	193.0±56.8	NS
LDL-C,f mg/dL	115.4±40.1	123.1±45.9	NS
LDL-C >100 mg/dL	59 (70.2)	1,527 (73.7)	NS
LDL-C >70 mg/dL	76 (90.5)	1,871 (90.3)	NS

Notes:

a As inferred from hospital discharge database;

b as inferred from preadmission prescription of specific drugs;

c as inferred from hospital case history;

d as inferred from 2,451 of 2,744 (89.3%) hospital case histories;

e as inferred from 2,479 of 2,744 (90.3%) hospital case histories;

f as inferred from 2,156 of 2,744 (78.6%) hospital case histories.

Abbreviations: SD, standard deviation; CV, cardiovascular; NS, not significant; CKD, chronic kidney disease; LDL-C, low-density-lipoprotein cholesterol.

Table 7 Study participant characteristics by level of adherence to statin treatment at follow-up

	Statin treatment at follow-up, n (%)/mean ± SD		P<
	Nonadherent MPR <80% 1,198 (45.6)	Adherent MPR ≥80% 1,431 (54.4)
Age, years	62.8±12.4	59.9±11.8	0.001
Sex, male	848 (70.8)	1,064 (74.4)	0.05
Hospitalization for CV reasons in the previous yeara	467 (39.0)	506 (35.4)	NS
Presence of diabetesa,b	319 (26.6)	331 (23.1)	0.05
Presence of CKDa	79 (6.6)	84 (5.9)	NS
Statin treatment during hospitalizationc	923 (77.0)	1,244 (86.9)	0.001
Prescription of statins at discharged	832 (79.1)	1,156 (88.9)	0.001
Total cholesterol,e mg/dL	155.0±52.4	191.4±60.3	NS
LDL-C,f mg/dL	123.7±43.8	122.5±47.6	NS
LDL-C >100 mg/dL	224 (24.6)	321 (27.7)	NS
LDL-C >70 mg/dL	84 (9.2)	117 (10.1)	NS

Notes:

a As inferred from hospital discharge database;

b as inferred from preadmission prescription of specific drugs;

c as inferred from hospital case history;

d as inferred from 2,353 of 2,629 (89.5%) hospital case histories;

e as inferred from 2,371 of 2,629 (90.2%) hospital case histories;

f as inferred from 2,072 of 2,629 (78.8%) hospital case histories.

Abbreviations: MPR, medication-possession ratio; SD, standard deviation; CV, cardiovascular; NS, not significant; CKD, chronic kidney disease; LDL-C, low-density-lipoprotein cholesterol.

Table 8 Daily dose of different types of statins prescribed during follow-up to those persistent with adherence to treatment ≥80%

Statin prescribed during follow-up	Daily dose, mg	Patients treated
		n	%
Atorvastatin	≤20	280	44.2
	>20–≤40	302	47.7
	>40	51	8.1
Pravastatin	≤30	34	26.4
	>30–≤60	92	71.3
	>60	3	2.3
Rosuvastatin	≤10	29	53.7
	>10–≤20	23	42.6
	>20	2	3.7
Simvastatin	≤30	275	45.7
	>30–≤60	321	53.3
	>60	6	1.0

Note: Fourteen patients treated with other statins were not considered.

Table 9 Logistic regression analysis to predict 2-year nonadherence to statin treatment

	RR	95% CI		P-value
		Inferior	Superior
Age, years	1.019	1.011	1.026	0.000
Sex	0.949	0.787	1.143	0.580
Previous statin treatment	0.664	0.542	0.814	0.000
Presence of diabetes	1.296	1.046	1.605	0.018
Previous CV hospitalizations	1.301	1.076	1.573	0.007
Presence of CKD	0.907	0.647	1.270	0.569
Statin treatment during hospitalization	0.564	0.454	0.701	0.000
Antihypertensive/antiplatelet treatment	0.380	0.243	0.593	0.000
Statin
Atorvastatin (reference)
Pravastatin	1.642	1.253	2.151	0.000
Rosuvastatin	1.576	1.055	2.355	0.026
Simvastatin	1.229	1.031	1.466	0.022
Other statins	2.429	1.233	4.785	0.010

Abbreviations: CI, confidence interval; RR, relative risk; CV, cardiovascular; CKD, chronic kidney disease.