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Adherence to lipid-lowering treatment impacts cardiovascular health

By Colin Kenny, Editor – Diabetes Distilled

Investigators wanted to analyse the risk of cardiovascular (CV) events and mortality in patients with type 2 diabetes mellitus in relation to how well they adhered to lipid-lowering medications. They analysed 12,914 patients with type 2 diabetes from across 1363 healthcare centres in Sweden. Patients started on lipid-lowering therapy during a 3-year period were followed from their first prescription until they had a first CV event. Compared with high-adherent patients, low-adherent primary prevention patients showed a higher risk of all outcomes including a doubling for all-cause mortality.

All Swedish patients aged 18 years or older who had filled at least one prescription for lipid-lowering medications between 2007 and 2010 were included in this analysis, including 121,914 patients with type 2 diabetes (mean age 63 years). Patients were classified as receiving primary or secondary prevention, depending on whether they had experienced a CV event or not, with 11.8% of the type 2 diabetes patients receiving lipid-lowering medication as secondary prevention. Patients’ adherence to lipid-lowering medications was assessed along with physician adherence to Swedish National guidelines.

Among patients with primary prevention, the mean refill adherence was 63.6%, ranging from 60.7% to 70.0% throughout the study period. Primary prevention patients with low refill adherence had a significantly higher risk of CV events, a higher risk of CV mortality and double the risk of all-cause mortality compared to those with high refill adherence. Those with low refill adherence who were receiving treatment for primary prevention from healthcare centres with low guideline adherence faced an approximately 9% higher risk of CV events.

Patients with low adherence to lipid-lowering medications had a higher risk of CV events and mortality in both prevention groups, independent of the centre’s guideline adherence level. 

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