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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
Author(s) -
Wei Li,
Fahey Tom,
MacDonald Thomas M.
Publication year - 2008
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2008.03212.x
Subject(s) - medicine , aspirin , cohort , statin , poisson regression , adverse effect , cohort study , confidence interval , disease , relative risk , population , environmental health
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Aspirin and statins are widely‐used drugs in patients with cardiovascular disease. • There is less information on healthy behaviour vs. drug effects. WHAT THIS STUDY ADDS • Long‐term adherence to aspirin and statin treatments in patients with established cardiovascular disease has been investigated. • Poor health behaviour is not a sufficient explanation of adverse outcome in poorly adherent patients. 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.