Adherence trajectories of oral lipid-lowering therapy in patients with myocardial infarction and its estimated impact on low-density lipoprotein levels
(2025) In Clinical Research in Cardiology- Abstract
Background: Low adherence to lipid-lowering therapy (LLT) after myocardial infarction (MI) is associated with increased risk of recurrent cardiovascular events and death. However, little is known about long-term adherence patterns following treatment interruptions. The aim of this study was to describe adherence trajectories in MI patients following a LLT treatment gap, and model the impact of different adherence trajectories on estimated low-density lipoprotein cholesterol (LDL-C) levels. Methods: We conducted a retrospective cohort study of 22,124 first-time MI patients in Sweden who dispensed statins and/or ezetimibe within 90 days of their MI. Patients with a treatment gap > 90 days within three years post-MI were identified, and... (More)
Background: Low adherence to lipid-lowering therapy (LLT) after myocardial infarction (MI) is associated with increased risk of recurrent cardiovascular events and death. However, little is known about long-term adherence patterns following treatment interruptions. The aim of this study was to describe adherence trajectories in MI patients following a LLT treatment gap, and model the impact of different adherence trajectories on estimated low-density lipoprotein cholesterol (LDL-C) levels. Methods: We conducted a retrospective cohort study of 22,124 first-time MI patients in Sweden who dispensed statins and/or ezetimibe within 90 days of their MI. Patients with a treatment gap > 90 days within three years post-MI were identified, and adherence trajectories were evaluated over a five-year period following the treatment gap using group-based trajectory modelling. Associations between adherence trajectories and patient characteristics were analyzed, and the impact on estimated LDL-C levels was simulated based on trajectory-specific adherence. Results: Patients were categorized in six different adherence trajectories — constant adherent (34%), constant non-adherent (26%), rapidly (7%) and slowly (6%) increasing and rapidly (9%) and slowly (19%) decreasing adherence. Patients with a constant adherent trajectory were more often managed in primary care (compared to hospital care). Lower age and male sex were also associated with a constant adherent trajectory. The average LDL-C level in patients with a constant adherence trajectory was estimated to be 1.0 mmol/L lower compared to patients with a constant non-adherence trajectory. Conclusions: Suboptimal adherence following a treatment gap is common and has a clinically significant impact on the degree of LDL-C lowering.
(Less)
- author
- Hagström, Emil ; Ortsäter, Gustaf ; Almlöf, Emil ; Vasilevska, Marija ; Leósdóttir, Margrét LU ; Wettermark, Björn ; Banefelt, Jonas and Larsen, Anders Peter
- organization
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- Adherence, Group-based trajectory models, Lipid-lowering therapy, Myocardial infarction
- in
- Clinical Research in Cardiology
- publisher
- Springer Science and Business Media B.V.
- external identifiers
-
- pmid:41329241
- scopus:105023870004
- ISSN
- 1861-0684
- DOI
- 10.1007/s00392-025-02791-5
- language
- English
- LU publication?
- yes
- id
- 04691008-571e-4b8b-be12-b39758ed800b
- date added to LUP
- 2025-12-19 13:15:46
- date last changed
- 2025-12-19 13:16:46
@article{04691008-571e-4b8b-be12-b39758ed800b,
abstract = {{<p>Background: Low adherence to lipid-lowering therapy (LLT) after myocardial infarction (MI) is associated with increased risk of recurrent cardiovascular events and death. However, little is known about long-term adherence patterns following treatment interruptions. The aim of this study was to describe adherence trajectories in MI patients following a LLT treatment gap, and model the impact of different adherence trajectories on estimated low-density lipoprotein cholesterol (LDL-C) levels. Methods: We conducted a retrospective cohort study of 22,124 first-time MI patients in Sweden who dispensed statins and/or ezetimibe within 90 days of their MI. Patients with a treatment gap > 90 days within three years post-MI were identified, and adherence trajectories were evaluated over a five-year period following the treatment gap using group-based trajectory modelling. Associations between adherence trajectories and patient characteristics were analyzed, and the impact on estimated LDL-C levels was simulated based on trajectory-specific adherence. Results: Patients were categorized in six different adherence trajectories — constant adherent (34%), constant non-adherent (26%), rapidly (7%) and slowly (6%) increasing and rapidly (9%) and slowly (19%) decreasing adherence. Patients with a constant adherent trajectory were more often managed in primary care (compared to hospital care). Lower age and male sex were also associated with a constant adherent trajectory. The average LDL-C level in patients with a constant adherence trajectory was estimated to be 1.0 mmol/L lower compared to patients with a constant non-adherence trajectory. Conclusions: Suboptimal adherence following a treatment gap is common and has a clinically significant impact on the degree of LDL-C lowering.</p>}},
author = {{Hagström, Emil and Ortsäter, Gustaf and Almlöf, Emil and Vasilevska, Marija and Leósdóttir, Margrét and Wettermark, Björn and Banefelt, Jonas and Larsen, Anders Peter}},
issn = {{1861-0684}},
keywords = {{Adherence; Group-based trajectory models; Lipid-lowering therapy; Myocardial infarction}},
language = {{eng}},
publisher = {{Springer Science and Business Media B.V.}},
series = {{Clinical Research in Cardiology}},
title = {{Adherence trajectories of oral lipid-lowering therapy in patients with myocardial infarction and its estimated impact on low-density lipoprotein levels}},
url = {{http://dx.doi.org/10.1007/s00392-025-02791-5}},
doi = {{10.1007/s00392-025-02791-5}},
year = {{2025}},
}