Long-Term Statin Adherence in Patients with Stable Angina after Coronary Stenting

Purpose. To study adherence to therapy with statins and its relation to development of cardio-vascular complications (CVC) in patients with stable angina after elective percutaneous coronary intervention (PCI) at five-year observation. Materials and methods. This study comprised 574 patients with stable angina (81% men, mean age 60.3 years) hospitalized for elective PCI. All patients were prescribed therapy in accordance with recommendations on management of stable angina including statins. Adherence to statin therapy after PCI was assessed in 1 year at telephone interview and in 5 years at ambulatory examination and by filling of an adherence questionnaire. The following CVCs were registered during follow-up after hospital discharge: deaths from all causes, cardiovascular deaths, nonfatal myocardial infarctions and strokes, repetitive myocardial revascularizations. Associations of these events with adherence to hypolipidemic therapy were finally analyzed. Results. Mean duration of follow-up was 53.5 (from 3.4 to 67.6) months. In 1 year 490 patients (84.5%) declared that they continued to take statins. In 5 years number of patients who continued taking statins was 380 (66.2%). Doses of statins were low (mean for simvastatin 17.4, atorvastatin - 15.8, rosuvastatin - 12.1 mg). Only in 8.7% of patients level of low density lipoprotein cholesterol (LDLC) was <1.8 mmol/L. During follow-up CVCs were registered in 24% of cases. Number of deaths was 29 (5.1%) including 4 noncardiac (0.7%). Repeat revascularizations were performed in 84 patients (14.6%). Nonfatal MI or stroke occurred in 17 (3%) and 8 (1.3%), respectively. Patients who reported use of statins at 1 year had lower rate of CVC compared with those who reported discontinuation (9 vs. 16.7%, odds ratio 2.3 [95% confidence interval 1.6 to 3.89], p=0.03). Total number of CVCs in 5 years was not different but among patients who continued statins there were significantly less deaths (2.9 vs. 9.3% among those who discontinued statins, p=0.0178). Conclusions. Adherence to therapy with statins both for first year and in 5 years after PCI despite use of mainly low doses and lack of achievement of target LDLC level was significantly associated with better prognosis.

статины, долгосрочная приверженность, чрескожное коронарное вмешательство, холестерин липопротеидов низкой плотности, statins, long-term adherence, percutaneous coronary intervention, low density lipoprotein cholesterol

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