A new study conducted in the U.S. and Romania has shown that, within two years after experiencing a myocardial infarction (MI), nearly one in five patients stop taking life-saving statins, and nearly two in five end up taking the drugs in lower doses or less often than they should, according to a Reuters report. The findings were published in JAMA Cardiology.
“From a societal perspective, we need to make sure the highest-risk individuals are being treated with guideline-directed therapy,” said senior author Dr. Robert Rosenson, a professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York City.
Statins include Lipitor (Pfizer), which is sold generically as atorvastatin, and Crestor (AstraZeneca), which is also known as rosuvastatin. They work by inhibiting cholesterol production in the liver.
Rosenson told Reuters that his team had previously found low use of high-intensity statins in people with previous heart attacks. The new study aimed to identify what traits were associated with discontinuing or reducing statins.
The retrospective cohort investigation assessed Medicare patients after hospitalization for MI. Medicare beneficiaries 66 to 75 years of age (n = 29,932) and older than 75 years (n = 27,956) hospitalized for MI between 2007 and 2012 who filled prescriptions for high-intensity statins (i.e., atorvastatin 40/80 mg and rosuvastatin 20/40 mg) within 30 days of discharge. The beneficiaries had Medicare fee-for-service coverage, including pharmacy benefits.
High adherence to high-intensity statins at six months and two years after discharge was defined by a proportion of days covered of at least 80%; down-titration was defined by switching to a low- or moderate-intensity statin with a proportion of days covered of at least 80%; and low adherence was defined by a proportion of days covered of less than 80% for any statin intensity without discontinuation. Discontinuation was defined as not having a statin available to take during the last 60 days of each follow-up period.
At six months and two years after discharge among beneficiaries 66 to 75 years of age, 59% (17,633) and 42% (10,308) were taking high-intensity statins with high adherence; 9% (2,605) and 13% (3,315) down-titrated; 17% (5,182) and 19% (4,727) had low adherence; and 12% (3,705) and 19% (4,648) discontinued their statins, respectively
African-American patients, Hispanic patients, and new high-intensity statin users were less likely to take high-intensity statins with high adherence. Conversely, those with dual Medicare/Medicaid coverage and more cardiologist visits after discharge and who participated in cardiac rehabilitation were more likely to take high-intensity statins with high adherence. These results were similar among beneficiaries older than 75 years of age.
The researchers concluded that lower costs, more cardiologist visits, and cardiac rehabilitation may boost the number of people staying on high-intensity statins and may ultimately reduce the risk of future heart attacks.
People should know that statins have benefits beyond just lowering low-density lipoprotein (LDL) cholesterol , also known as “bad” cholesterol, Rosenson said. They also have anti-inflammatory benefits.
“I think what the public needs to know is discontinuing or down-titrating your statins is associated with a greater risk of having a second heart attack and of being in the hospital with a cardiovascular event that may result in a procedure that results in higher health care cost for them and the entire public,” he told Reuters.