Persistence of atorvastatin and simvastatin among patients with and without prior cardiovascular diseases: a US managed care study

ABSTRACT Background: In clinical practice, persistence with statin therapy is poor. While little is known about relative persistence to specific statins, previous studies have observed greater persistence in patients who achieve greater degrees of lipid lowering. Identification of statin therapies w...

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Bibliographic Details
Published in:Current medical research and opinion 2008-07, Vol.24 (7), p.1987-2000
Main Authors: Foody, JoAnne M., Joyce, Amie T., Rudolph, Amy E., Liu, Larry Z., Benner, Joshua S.
Format: Article
Language:English
Subjects:
Adherence
Adult
Aged
Atorvastatin
Cardiovascular Diseases - drug therapy
Cardiovascular Diseases - mortality
Cardiovascular Diseases - prevention & control
Cohort Studies
Databases, Factual
Drug Utilization Review
Female
Heptanoic Acids - administration & dosage
Humans
Hydroxymethylglutaryl-CoA reductase inhibitors
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage
Hyperlipidemia
Male
Middle Aged
Persistence
Pyrroles - administration & dosage
Simvastatin - administration & dosage
Statins
Survival Analysis
United States - epidemiology
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Summary:ABSTRACT Background: In clinical practice, persistence with statin therapy is poor. While little is known about relative persistence to specific statins, previous studies have observed greater persistence in patients who achieve greater degrees of lipid lowering. Identification of statin therapies which improve patient persistence has the potential to improve the quality of patient care and clinical outcomes. Therefore, we assessed patient persistence with atorvastatin and simvastatin in primary and secondary prevention patients enrolled in managed care. Methods: New statin users aged ≥18 years, both with and without prior cardiovascular (CV) events within the 12 month pre-treatment period, were identified from a large national database of managed care patients. Patients initiated atorvastatin or simvastatin therapy from January 1, 2003 to September 30, 2005 and were continuously enrolled in a covered plan for at least 12 months before and after initiation of statin therapy. Subanalyses of patients ≥65 years were also conducted. Measures of interest included demographic and clinical characteristics of the study samples and persistence of statin utilization over the 1-year follow-up period. Persistence was defined as the number of days a patient remained on treatment in the first year following their index date, measured from the date of first fill to study end or the date of discontinuation. Results: A total of 129 764 atorvastatin users and 45 558 simvastatin users without prior CV events were included in the study. For those patients with prior CV events, a total of 6888 atorvastatin users and 4443 simvastatin users were included in the study. Median persistence in patients without prior CV events was 50 days longer for patients initiating therapy with atorvastatin than simvastatin (207 vs. 157 days, p 
ISSN:0300-7995
1473-4877
DOI:10.1185/03007990802203279