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Methods Cohort Development and Study Population Therefore, using data from a national cohort of patients with CVD, we aimed to determine whether the use of high-intensity statin therapy is associated with a lower adherence to statin medications compared with low- to moderate-intensity statin therapy. This has implications as health care providers adopt the recent cholesterol guideline 1 into clinical practice. Although it is possible that a higher risk of side effects from high-intensity statin therapy could affect medication adherence compared with low-intensity statin therapy, this issue has not been well explored in the literature. Evaluation of safety data indicates that high-intensity statin therapy is also accompanied by increased side effects and adverse events, posing a risk to adherence in CVD patients treated with high-intensity statins. 1 This is based on studies showing that statin therapy, 2- 4 and more important, high-intensity statin therapy, 5- 7 is associated with an improvement in cardiovascular outcomes compared with low-intensity statin therapy.Īlthough a number of studies have compared high-intensity statins with low- or moderate-intensity statins, 5- 7 most have focused on evaluating the effectiveness of these therapies in reducing CVD events and improving prognosis. The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on treatment of blood cholesterol recommends high-intensity statin use in most patients with cardiovascular disease (CVD). However, this change may be associated with a very modest reduction in statin adherence compared with low- to moderate-intensity therapy that is unlikely to be of clinical significance. ConclusionsĪn approach of high-intensity statin therapy will lead to a significant practice change, as the majority of CVD patients are not on high-intensity therapy. In adjusted analyses, high-intensity statin use was associated with a significant but modest PDC reduction compared with low- to moderate-intensity statin use, whether PDC was assessed as a continuous (β-coefficient: −0.008, P < 0.0001) or categorical (PDC ≥0.80 ) measure of statin adherence. Mean PDC (0.87 vs 0.86, P < 0.0001) and patients with PDC ≥0.80 (76.3% vs 74.2%, P < 0.0001) were slightly higher for those receiving low- to moderate-intensity compared with high-intensity statins. Of those, 229 437 (36.5%) received high-intensity statins. We assessed statin adherence by calculating proportion of days covered (PDC) and determined whether high-intensity statin therapy was independently associated with a lower PDC. In a national database of 972 532 CVD patients from the Veterans Health Administration, we identified patients receiving statins between October 1, 2010, and September 30, 2011. High-intensity statins are associated with lower adherence compared with low- to moderate-intensity statins.
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Therefore, it may be of concern that these recommendations might reduce statin adherence. High-intensity statins are associated with more frequent side effects. No difference in terms of PFS and OS was found according to the type and lipophilicity of statins.The recent cholesterol guideline recommends high-intensity statins in cardiovascular disease (CVD) patients. Comparing them with no users, we found no differences in terms of ORR ( P = 0.14) and OS ( P = 0.33) and only a trend towards better PFS ( P = 0.06). The same benefit was not observed for pts receiving low/moderate-intensity statins. Use of high-intensity statins compared to no use was associated with increased ORR (46% versus 18%, P = 0.05), better PFS (median not reached versus 3.0 months, HR 0.33, 95% CI 0.15–0.75, P < 0.01), and better OS (median not reached versus 9.1 months, HR 0.20, 95% CI 0.05–0.84, P = 0.02). Twenty-seven out of 80 (34%) MPM and 40 out of 173 (20%) NSCLC pts were taking statins at start of PD1 inhibitors.