TY - JOUR
T1 - Association Between Lipid Testing and Statin Adherence in the Veterans Affairs Health System
AU - Jia, Xiaoming
AU - Al Rifai, Mahmoud
AU - Ramsey, David J.
AU - Ahmed, Sarah T.
AU - Akeroyd, Julia M.
AU - Nambi, Vijay
AU - Ballantyne, Christie M.
AU - Petersen, Laura A.
AU - Stone, Neil J.
AU - Virani, Salim S.
N1 - Funding Information:
VN serves as the site primary investigator on a study sponsored by Merck, holds a provisional patent on biomarkers for the prediction of heart failure along with Baylor College of Medicine and Roche and is an event adjudicator on a study sponsored by Siemens. CMB Grant/Research Support (all significant; all paid to institution, not individual): Akcea, Amarin, Amgen, Esperion, Novartis, Regeneron, Sanofi-Synthelabo, National Institutes of Health, American Heart Association, American Diabetes Association. Consultant: Akcea, Amarin, Amgen, Astra Zeneca, Eli Lilly, Esperion, Matinas BioPharma Inc, Merck, Novartis, Regeneron, Sanofi-Synthelabo. SSV has grant funding from the Department of Veteran Affairs, American Heart Association, American Diabetes Association, Drs. Tahira and Nuruddin Jooma Fund; honorarium from American College of Cardiology (Associate Editor for Innovations ACC.org ), and the National Lipid Association, and serves on the steering committee for the Patient and Provider Assessment of Lipid Management (PALM) Registry at the Duke Clinical Research Institute (no financial remuneration). Others: None.
Funding Information:
This work was supported by a Department of Veterans Affairs Health Services Research and Development (HSR&D) Service Investigator Initiated Grant ( IIR 16-072 ), American Heart Association Beginning Grant-in-Aid ( 14BGIA20460366 ), the American Diabetes Association Clinical Science and Epidemiology award ( 1-14-CE-44 ), and the Houston VA HSR&D Center for Innovations grant (grant CIN13-413 ). The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs, the US government or Baylor College of Medicine.
Funding Information:
Funding: This work was supported by a Department of Veterans Affairs Health Services Research and Development (HSR&D) Service Investigator Initiated Grant (IIR 16-072), American Heart Association Beginning Grant-in-Aid (14BGIA20460366), the American Diabetes Association Clinical Science and Epidemiology award (1-14-CE-44), and the Houston VA HSR&D Center for Innovations grant (grant CIN13-413). The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs, the US government or Baylor College of Medicine.
Publisher Copyright:
© 2019
PY - 2019/9
Y1 - 2019/9
N2 - Background: Measurement with a lipid panel after statin initiation and in long-term follow-up is recommended in both 2013 and 2018 cholesterol guidelines to assess statin efficacy and adherence. We assessed whether routine laboratory evaluation with lipid panels is associated with greater statin adherence. Methods: We identified patients with atherosclerotic cardiovascular disease within the entire Veterans Affairs (VA) health care system with at least one primary care visit between October 2013 and September 2014, who were on statin therapy (n = 813,887; n = 52,583 for new statin users). Statin adherence was determined using medication refill data and assessed by proportion of days covered (PDC). Association between number of lipid panels completed and PDC was assessed with adjusted regression models. Results: Within the study period, the mean number of lipid panels that were completed per patient was 1.5 ± 1.0. In the overall cohort, percentage of statin users with PDC ≥ 80% was 66.0% for patients with ≥ 1 lipid panel and 61.2% for patients with 0 lipid panels (P <.0001). Among new statin users, PDC ≥ 80% was 68.0% for patients with lipid panels completed within 4-12 weeks of therapy initiation and 59.3% for those without lipid panels completed within the timeframe (P <.0001). In adjusted analysis, number of lipid panels completed was associated with a modest but significant increase in PDC, when PDC was evaluated as a continuous (beta-coefficient 0.0054, P <.001) or categorical (PDC ≥ 80% [odds ratio (OR) 1.01; 95% confidence interval (CI), 1.00-1.01]) measure of statin adherence. The significant association was also observed in new users (beta-coefficient 0.0058, P <.001; OR 1.02; 95% CI, 1.00-1.03). Conclusion: Routine, guideline-directed completion of lipid panels in atherosclerotic cardiovascular disease patients on statins overall and among new statin users is associated with a modes6t but significant increase in statin adherence.
AB - Background: Measurement with a lipid panel after statin initiation and in long-term follow-up is recommended in both 2013 and 2018 cholesterol guidelines to assess statin efficacy and adherence. We assessed whether routine laboratory evaluation with lipid panels is associated with greater statin adherence. Methods: We identified patients with atherosclerotic cardiovascular disease within the entire Veterans Affairs (VA) health care system with at least one primary care visit between October 2013 and September 2014, who were on statin therapy (n = 813,887; n = 52,583 for new statin users). Statin adherence was determined using medication refill data and assessed by proportion of days covered (PDC). Association between number of lipid panels completed and PDC was assessed with adjusted regression models. Results: Within the study period, the mean number of lipid panels that were completed per patient was 1.5 ± 1.0. In the overall cohort, percentage of statin users with PDC ≥ 80% was 66.0% for patients with ≥ 1 lipid panel and 61.2% for patients with 0 lipid panels (P <.0001). Among new statin users, PDC ≥ 80% was 68.0% for patients with lipid panels completed within 4-12 weeks of therapy initiation and 59.3% for those without lipid panels completed within the timeframe (P <.0001). In adjusted analysis, number of lipid panels completed was associated with a modest but significant increase in PDC, when PDC was evaluated as a continuous (beta-coefficient 0.0054, P <.001) or categorical (PDC ≥ 80% [odds ratio (OR) 1.01; 95% confidence interval (CI), 1.00-1.01]) measure of statin adherence. The significant association was also observed in new users (beta-coefficient 0.0058, P <.001; OR 1.02; 95% CI, 1.00-1.03). Conclusion: Routine, guideline-directed completion of lipid panels in atherosclerotic cardiovascular disease patients on statins overall and among new statin users is associated with a modes6t but significant increase in statin adherence.
KW - Atherosclerotic cardiovascular disease
KW - Lipid panel
KW - Statin adherence
UR - http://www.scopus.com/inward/record.url?scp=85067179185&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2019.04.002
DO - 10.1016/j.amjmed.2019.04.002
M3 - Article
C2 - 31103643
AN - SCOPUS:85067179185
SN - 0002-9343
VL - 132
SP - e693-e700
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 9
ER -
