Adherence to statin or aspirin or both in patients with established cardiovascular disease: exploring healthy behaviour vs. drug effects and 10-year follow-up of outcome

Li Wei, Tom Fahey, Thomas M. MacDonald

    Research output: Contribution to journalArticle

    42 Citations (Scopus)

    Abstract

    Aims

    To characterize adherence in patients with established cardiovascular disease taking statins and aspirin and to estimate the effects of adherence due to health behaviour, a lack of beneficial drug effect, or both on recurrence of cardiovascular disease or all-cause mortality over 10 years.

    Methods

    A population-based cohort study using a record-linkage database in Tayside, Scotland. Subjects with cardiovascular disease (n = 7657; 4185 aspirin-alone cohort, 671 statin-alone cohort and 2801 combination use cohort) were studied between 1993 and 2003. The effects of adherence on recurrence of cardiovascular disease or mortality were assessed using Poisson regression model.

    Results

    In subjects taking both aspirin and statins, those adherent to statins but not aspirin had a lower risk of recurrence [adjusted risk ratio (RR) 0.64; 95% confidence interval 0.49, 0.82], but those adherent to aspirin but not statins has no such effect (adjusted RR 0.91; 0.72, 1.15), suggesting that adherence behaviour alone was not responsible for the beneficial effect. Within the group adherent to aspirin, >= 80% adherence to statins was associated with reduced recurrence compared with those poorly adherent (adjusted RR 0.76; 0.62, 0.94), but no such effect of aspirin was seen in those adherent to statins. Similar results were found for all-cause mortality.

    Conclusions

    Poor health behaviour is not a sufficient explanation of adverse outcome in poorly adherent patients. Adverse outcome is more likely to be driven by foregone drug benefits.

    Original languageEnglish
    Pages (from-to)110-116
    Number of pages7
    JournalBritish Journal of Clinical Pharmacology
    Volume66
    Issue number1
    DOIs
    Publication statusPublished - Jul 2008

    Keywords

    • aspirin
    • cardiovascular recurrence
    • long-term adherence
    • statin
    • MYOCARDIAL-INFARCTION
    • CHOLESTEROL
    • MORTALITY
    • THERAPY
    • METAANALYSIS
    • MEDICATIONS
    • ASSOCIATION
    • PERSISTENCE
    • POPULATION
    • IBUPROFEN

    Cite this

    @article{60be6e53d48f4a7293caa0a447d8323d,
    title = "Adherence to statin or aspirin or both in patients with established cardiovascular disease: exploring healthy behaviour vs. drug effects and 10-year follow-up of outcome",
    abstract = "AimsTo characterize adherence in patients with established cardiovascular disease taking statins and aspirin and to estimate the effects of adherence due to health behaviour, a lack of beneficial drug effect, or both on recurrence of cardiovascular disease or all-cause mortality over 10 years.MethodsA population-based cohort study using a record-linkage database in Tayside, Scotland. Subjects with cardiovascular disease (n = 7657; 4185 aspirin-alone cohort, 671 statin-alone cohort and 2801 combination use cohort) were studied between 1993 and 2003. The effects of adherence on recurrence of cardiovascular disease or mortality were assessed using Poisson regression model.ResultsIn subjects taking both aspirin and statins, those adherent to statins but not aspirin had a lower risk of recurrence [adjusted risk ratio (RR) 0.64; 95{\%} confidence interval 0.49, 0.82], but those adherent to aspirin but not statins has no such effect (adjusted RR 0.91; 0.72, 1.15), suggesting that adherence behaviour alone was not responsible for the beneficial effect. Within the group adherent to aspirin, >= 80{\%} adherence to statins was associated with reduced recurrence compared with those poorly adherent (adjusted RR 0.76; 0.62, 0.94), but no such effect of aspirin was seen in those adherent to statins. Similar results were found for all-cause mortality.ConclusionsPoor health behaviour is not a sufficient explanation of adverse outcome in poorly adherent patients. Adverse outcome is more likely to be driven by foregone drug benefits.",
    keywords = "aspirin, cardiovascular recurrence, long-term adherence, statin, MYOCARDIAL-INFARCTION, CHOLESTEROL, MORTALITY, THERAPY, METAANALYSIS, MEDICATIONS, ASSOCIATION, PERSISTENCE, POPULATION, IBUPROFEN",
    author = "Li Wei and Tom Fahey and MacDonald, {Thomas M.}",
    year = "2008",
    month = "7",
    doi = "10.1111/j.1365-2125.2008.03212.x",
    language = "English",
    volume = "66",
    pages = "110--116",
    journal = "British Journal of Clinical Pharmacology",
    issn = "0306-5251",
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    number = "1",

    }

    TY - JOUR

    T1 - Adherence to statin or aspirin or both in patients with established cardiovascular disease

    T2 - exploring healthy behaviour vs. drug effects and 10-year follow-up of outcome

    AU - Wei, Li

    AU - Fahey, Tom

    AU - MacDonald, Thomas M.

    PY - 2008/7

    Y1 - 2008/7

    N2 - AimsTo characterize adherence in patients with established cardiovascular disease taking statins and aspirin and to estimate the effects of adherence due to health behaviour, a lack of beneficial drug effect, or both on recurrence of cardiovascular disease or all-cause mortality over 10 years.MethodsA population-based cohort study using a record-linkage database in Tayside, Scotland. Subjects with cardiovascular disease (n = 7657; 4185 aspirin-alone cohort, 671 statin-alone cohort and 2801 combination use cohort) were studied between 1993 and 2003. The effects of adherence on recurrence of cardiovascular disease or mortality were assessed using Poisson regression model.ResultsIn subjects taking both aspirin and statins, those adherent to statins but not aspirin had a lower risk of recurrence [adjusted risk ratio (RR) 0.64; 95% confidence interval 0.49, 0.82], but those adherent to aspirin but not statins has no such effect (adjusted RR 0.91; 0.72, 1.15), suggesting that adherence behaviour alone was not responsible for the beneficial effect. Within the group adherent to aspirin, >= 80% adherence to statins was associated with reduced recurrence compared with those poorly adherent (adjusted RR 0.76; 0.62, 0.94), but no such effect of aspirin was seen in those adherent to statins. Similar results were found for all-cause mortality.ConclusionsPoor health behaviour is not a sufficient explanation of adverse outcome in poorly adherent patients. Adverse outcome is more likely to be driven by foregone drug benefits.

    AB - AimsTo characterize adherence in patients with established cardiovascular disease taking statins and aspirin and to estimate the effects of adherence due to health behaviour, a lack of beneficial drug effect, or both on recurrence of cardiovascular disease or all-cause mortality over 10 years.MethodsA population-based cohort study using a record-linkage database in Tayside, Scotland. Subjects with cardiovascular disease (n = 7657; 4185 aspirin-alone cohort, 671 statin-alone cohort and 2801 combination use cohort) were studied between 1993 and 2003. The effects of adherence on recurrence of cardiovascular disease or mortality were assessed using Poisson regression model.ResultsIn subjects taking both aspirin and statins, those adherent to statins but not aspirin had a lower risk of recurrence [adjusted risk ratio (RR) 0.64; 95% confidence interval 0.49, 0.82], but those adherent to aspirin but not statins has no such effect (adjusted RR 0.91; 0.72, 1.15), suggesting that adherence behaviour alone was not responsible for the beneficial effect. Within the group adherent to aspirin, >= 80% adherence to statins was associated with reduced recurrence compared with those poorly adherent (adjusted RR 0.76; 0.62, 0.94), but no such effect of aspirin was seen in those adherent to statins. Similar results were found for all-cause mortality.ConclusionsPoor health behaviour is not a sufficient explanation of adverse outcome in poorly adherent patients. Adverse outcome is more likely to be driven by foregone drug benefits.

    KW - aspirin

    KW - cardiovascular recurrence

    KW - long-term adherence

    KW - statin

    KW - MYOCARDIAL-INFARCTION

    KW - CHOLESTEROL

    KW - MORTALITY

    KW - THERAPY

    KW - METAANALYSIS

    KW - MEDICATIONS

    KW - ASSOCIATION

    KW - PERSISTENCE

    KW - POPULATION

    KW - IBUPROFEN

    U2 - 10.1111/j.1365-2125.2008.03212.x

    DO - 10.1111/j.1365-2125.2008.03212.x

    M3 - Article

    C2 - 18492127

    VL - 66

    SP - 110

    EP - 116

    JO - British Journal of Clinical Pharmacology

    JF - British Journal of Clinical Pharmacology

    SN - 0306-5251

    IS - 1

    ER -