OBJECTIVES : Patients with history of myocardial infarction (MI) are at very-high risk of subsequent cardiovascular events (CVE). Our study investigates the association between adherence and intensity and risk of cardiovascular disease in a representative population of German patients.

METHODS : Data on post-MI patients were obtained between 2010 and 2015 from the German Institut für angewandte Gesundheitsforschung (InGef) health claims database. The study included patients ≥18 years, on initial LLT (statins and/or ezetimibe) in 2011-2013, diagnosed with an MI. Patients had to have at least 2 LLT prescriptions during the first year of follow-up. Follow-up period started 1 year after the second LLT prescription and continued until a hospitalization for an MI, unstable angina, ischemic stroke, heart failure, revascularization, all-cause death, or the end of follow-up, whichever occurred first. Treatment intensity was quantified based on expected LDL-C reduction as described in the American College of Cardiology and American Heart Association 2018 guidelines. Adherence was measured by the proportion of days covered (PDC) annually. Adherence and treatment intensity were multiplied to create a combined measure of LLT intensity after accounting for adherence. Associations were evaluated with Cox proportional hazards models controlling for age, sex, comorbidities, and other important cardiovascular risk factors at baseline.

RESULTS : 14,944 post-MI patients were 67 (SD=13) years old, 69% men, and followed-up for 2.9 (SD=1.1) years. A 10% increase in treatment intensity (LDL-C lowering) was associated with a 20% decrease in risk of CVE/death (HR=0.80; 95% CI: 0.78-0.82). Similarly, a 10% increase in PDC (adherence) was associated with a 8% reduced risk of CVE/death (HR=0.92; 0.91-0.93). Finally, a 10% increase in adherence-adjusted LLT intensity was associated with 21% lower risk of CVE/death (HR=0.79; 0.78-0.82).

CONCLUSIONS : A higher adherence and/or treatment intensity of LLT were associated with significantly lower risk of cardiovascular outcomes or all-cause death in German post-MI patients.