Impact de la prise prolongée (5 ans) de statines en prévention secondaire : l'étude IMPRES.

Aims: Despite proven benefits of LDL-C lowering among those with atherosclerotic cardiovascular disease (ASCVD), statin adherence remains low. Very little real-world data exist on the effect of long-term statin adherence on cardiovascular outcomes.

Methods and results: A total of 7,339 patients ≥18 years first diagnosed with ASCVD with a statin prescription within 12-months of diagnosis who had 5-years of continuous Select Health insurance or died during years 2-5 while a member were studied. The proportion of days covered (PDC) was calculated using pharmacy claims for statin use by year, and patients were stratified into pre-defined categories: Fully-adherent (PDC≥80% for years 1-5 or until death, n = 353[4.8%]), Short-term-adherent (PDC≥80% for years 1-3, n = 330[4.5%]), Early-adherent-only (PDC≥80% for year 1, n = 890[12.1%]), Complex-adherent (PDC≥80% in any of years 2-5, but not year 1, n = 1,292[17.6%]), and Non-adherent (PDC<80% for years 1-5 or until death, n = 3,942[72.1%]). Patients were followed for major adverse clinical events (MACE=death, MI, and stroke). Patients averaged 56.4±9.6 years and 76.5% were male. During year 1, statin adherence was poor, with PDC<20% in 4,007 (54.6%) patients and PDC ≥80% in 1,573 (21.4%) patients, which dropped to 16.9% by year 5. Increased adherence was associated with significantly fewer MACE (11.6%, 17.9%, 21.9%, 21.1%, and 26.4% for those fully-adherent, short-term-adherent, early-adherent only, complex-adherent, and non-adherent, respectively, p-trend<0.0001). After adjustment, fully-adherent was associated with a significant decrease in MACE (HR = 0.51 [0.37, 0.71]).

Conclusion: Among ASCVD patients with at least 5-years of continuous pharmacy benefits, long-term adherence to statins was associated with decreased long-term MACE in a linear-fashion.