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J Clin Lipidol. 2018 Nov 15. pii: S1933-2874(18)30463-X. doi: 10.1016/j.jacl.2018.11.004. [Epub ahead of print]

Higher long-term adherence to statins in rural patients at high atherosclerotic risk.

Author information

1
Department of Cardiology, St. Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Parkville, Melbourne, Australia. Electronic address: matthewpeverelle@gmail.com.
2
Department of Cardiology, St. Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Parkville, Melbourne, Australia.
3
Department of Medicine, University of Melbourne, Parkville, Melbourne, Australia.
4
School of Health and Life Sciences, Federation University of Australia, Melbourne, Australia; Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
5
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
6
General internal Medicine Unit, Western Health, St. Albans, Melbourne, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.

Abstract

BACKGROUND:

Rural patients with atherosclerotic cardiovascular disease (ASCVD) experience greater cardiovascular morbidity and mortality than their urban counterparts. Statin therapy is a key component of ASCVD treatment. The extent to which there may be regional differences in long-term adherence to statins is unknown.

OBJECTIVE:

To assess long-term rates of adherence to statins in a high-risk ASCVD cohort, and whether regional differences exist between rural and urban patients.

METHODS:

Follow-up was conducted in patients who underwent coronary angiography at a single tertiary center between 2009 and 2013. Adherence was defined as consumption of prescribed statin ≥6 days per week. Patients were divided into remoteness areas (RAs), classified as RA1 (major city), RA2 (inner regional), and RA3 (outer regional) based on the Australian Standard Geographical Classification.

RESULTS:

Five hundred twenty-five patients (69% male, mean age 64 ± 11 years) were followed-up after a median of 5.3 years. Baseline characteristics were similar between RAs. Overall adherence was 83%; however, rural patients were significantly more adherent to their statin therapy (80% in RA1, 83% in RA2, and 93% in RA3, P = .04). Living in RA3 independently predicted greater statin adherence than living in RA1 (odds ratio: 2.75, 95% CI: 1.1-7.8, P = .03). All-cause mortality was significantly higher in RA3 than other regional areas (6% RA1, 12% RA2, and 18% RA3, P = .01).

CONCLUSIONS:

Despite higher all-cause mortality, rural patients with ASCVD demonstrate significantly greater long-term adherence to statins than urban patients. Other factors, such as reduced access to health care and delayed diagnosis may explain the gap in outcomes between rural and urban patients.

KEYWORDS:

Atherosclerotic cardiovascular disease; Coronary artery disease; Hydroxymethylglutaryl-CoA reductase inhibitors; Medication adherence; Patient compliance

PMID:
30594444
DOI:
10.1016/j.jacl.2018.11.004

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