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Cited by 76Medication Adherence and ComplianceLipoproteins and Cardiovascular HealthPharmaceutical Practices and Patient Outcomes

Long-term persistence with statin therapy: A nationwide register study in Finland

Helin-Salmivaara, Arja, Lavikainen, Piia, Korhonen, Maarit J., Halava, Heli, Junnila, Seppo Y.T., Kettunen, Raimo, Neuvonen, Pertti J., Martikainen, Jaana E. +2 more·2008·Clinical Therapeutics
DOI 10.1016/j.clinthera.2008.12.003
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Abstract

Background Preventive statin therapy is often recommended as lifelong treatment.Objective The aim of this study was to analyze persistence with statin therapy over a decade of use and to identify factors associated with its discontinuation.Methods Persistence with therapy among new users of statins in 1995 was followed up until December 31, 2005, in Finland using the nationwide drug reimbursement register. Cumulative persistence was analyzed using Kaplan-Meier analysis. A Cox regression model was applied to analyze associations of various baseline covariates with discontinuation. We further modeled the association of time-specific covariates by stratifying the duration of therapy in years and using a logistic regression in which those continuing therapy until the end of follow-up (persistent users) formed the reference group. Adherence, defined as the proportion of days covered by statins, stratified by the timing of discontinuation, was computed for the respective groups.Results Of the 18,072 new statin users, 73.3% (n =13,254) were aged >54 years and 54.8% (n =9908) were men. Of this cohort, 43.9% (n = 7926) were using statins throughout and at the end of the tenth year. Sex was not associated with persistence at any point. In the Cox model, persons aged 45 to 74 years at initiation were more likely to continue statin use than younger or older age groups. Among those who still used statins after the fifth year of observation, the age difference was not observed in the logistic regression model. The use of 1, 2, 3, or > or =4 cardiovascular drugs before the initiation predicted continuation relative to no cardiovascular drug use (hazard ratio for discontinuation significantly <1.00 in all comparisons). Adherence was best (median 93.9%) among the persistent users.Conclusions The 10-year persistence with statin use in this general population was approximately 44%. Persons aged 45 to 74 years at initiation and those with at least 1 prescription for another cardiovascular medication were the most likely to continue statin therapy up to the fifth year.

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Crossref · 10.1016/j.clinthera.2008.12.003

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Authors
Helin-Salmivaara, A., Lavikainen, P., Korhonen, M. J., Halava, H., Junnila, S. Y. T., Kettunen, R., Neuvonen, P. J., Martikainen, J. E., Ruokoniemi, P., & Saastamoinen, L. K.
Affiliations
  • University of Eastern Finland (FI)
  • University of Turku (FI)
  • University of Helsinki (FI)
  • Social Insurance Institution (FI)
ORCID
Venue
Clinical Therapeutics
Publisher
Elsevier BV
Published
2008
Volume
30
Pages
2228-2240
ISSN
0149-2918 (ISSN-L)
DOI
10.1016/j.clinthera.2008.12.003
OpenAlex
W2017946113
Cited by
76
References
23
Citations by year
2024: 5 · 2023: 5 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 4 · 2014: 5 · 2013: 4 · 2012: 4
FWCI
3.78
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Clinical Therapeutics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
statin therapy, treatment persistence, drug discontinuation, medication adherence, age at initiation, long-term drug use
MeSH terms
Age Factors, Aged, Cardiovascular Agents, Female, Finland, Humans, Male, Middle Aged, Occupations, Registries, Logistic Models, Drug Monitoring, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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