Investigating the impact of statin intensity on patients

Investigating the impact of statin intensity on patients’ discontinuation of statin therapy A nationwide cohort study Tanja Mueller 1, Renata Cristina R. Macedo do Nascimento 2, Marion Bennie 1, 3, Brian Godman 1, 4, Simon Hurding 5, Sean Mac. Bride Steward 6, Augusto Afonso Guerra Junior 7, Francisco de Assis Acurcio 7, Alex Morton 1, Amanj Kurdi 1 1 University of Strathclyde, Glasgow, UK; 2 Federal University of Ouro Preto, Brazil; 3 NHS National Services Scotland, Edinburgh, UK; 4 Karolinska Institutet, Stockholm, Sweden; 5 The Scottish Government, Edinburgh, UK; 6 NHS Greater Glasgow & Clyde, Glasgow, UK; 7 Federal University of Minas Gerais, Belo Horizonte, Brazil Background Methods In the UK, high-intensity statin therapy is recommended for secondary prevention of cardiovascular disease. However, information regarding the impact of high statin doses on treatment discontinuation is limited. • Prescribing Information System (PIS) • Scottish Morbidity Records, inpatient dataset (SMR 01) Retrospective cohort study (January 2009 – December 2016) Study Objective • Incident statins patients ≥ 18 years • By intensity 1 • By prior CVD To evaluate the impact of highintensity therapy on statin discontinuation in Scotland. • Refill-gap method • Kaplan-Meier curves • Cox Proportional Hazard models Results • 73, 716 patients included • 10, 632 with prior CVD (14. 4%) • 7, 163 patients on high intensity therapy (9. 7%): 1, 834 with prior CVD (17. 2%), 5, 329 without (8. 4%) Figure 1: Kaplan-Meier by statin intensity, stratified by prior CVD status Table 1: Crude discontinuation rates High intensitya Moderate intensityb Low intensityc All intensity All patients 50. 9% 63. 9% 75. 5% 62. 9% Prior CVD 36. 3% 50. 4% 58. 8% 48. 0% No prior CVD 55. 9% 66. 0% 76. 3% 65. 4% atorvastatin 20 -80 mg; rosuvastatin 20 -40 mg; simvastatin 80 mg b atorvastatin 10 mg; fluvastatin 80 mg; lovastatin 40 mg; pravastatin 40 -80 mg; rosuvastatin 510 mg; simvastatin 20 -40 mg c fluvastatin 20 -40 mg; lovastatin 10 -20 mg; pravastatin 10 -20 mg; simvastatin 10 mg a 72. 3% of patients re-initiated therapy after a first discontinuation – the majority (72. 7%) with the same intensity as before References 1 NICE. Lipid-modifying drugs, 2017 Contact tanja. muller@strath. ac. uk Hazard ratios (HR) for discontinuation of high intensity treatment as compared to moderate intensity, adjusted for year of treatment initiation, sex, deprivation, and age and comorbidities at baseline • Patients with prior CVD: HR 0. 43 (95% CI 0. 34 – 0. 55) • Patients without prior CVD: HR 0. 80 (95% CI 0. 74 – 0. 86) Conclusion Compared to moderate and low intensity, high-intensity statin therapy was associated with lower discontinuation rates.