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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EAnalysis of over 45\u2005000 Medicare beneficiaries revealed that patients who adhere well to high-intensity statins or low-\/moderate-intensity statins have fewer recurrences of myocardial infarction, fewer hospitalizations due to cardiovascular disease, and fewer all-cause mortalitites. The reality, however, is that down-titration or discontinuation of high-intensity statins following hospital discharge is common.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eadherence\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eall-cause mortality\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehigh-intensity statins\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMedicare beneficiaries\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EExamination of hospital records of over 45\u2005000 Medicare beneficiaries aged \u2265\u200566 years has revealed that high adherence to statin therapy, regardless of statin intensity, is beneficial following discharge after hospitalization for myocardial infarction (MI). Yet, low adherence to therapy or discontinuation is common.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe researchers, including Robert S. Rosenson, MD, Mount Sinai Icahn School of Medicine, New York City, New York, USA, and Paul Muntner, PhD, University of Alabama Birmingham, Birmingham, Alabama, USA recently reported that only 27% of 8762 randomly sampled Medicare beneficiaries hospitalized for coronary heart disease events received high-intensity statins [Rosenson RS et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2015]. The present study was undertaken as a further exploration of the finding.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe study initially enrolled 969\u2005040 Medicare beneficiaries aged \u2265\u200566 years and \u0026lt;\u2005110 years who were hospitalized at the aforementioned institutions for MI between 2006 and 2012. This initial population was whittled down to 45\u2005629 individuals whose first statin prescription following discharge was for a high-intensity statin (atorvastatin, 40 or 80 mg; rosuvastatin, 20 or 40 mg; or simvastatin, 80 mg). The pattern of statin use at 182 days following discharge was ascertained, with maintenance of therapy for \u2265\u200580% of the time deemed high adherence and \u0026lt;\u200580% of the time reflecting low adherence. Other patterns analyzed included down-titration and subsequent high adherence to moderate- or low-intensity statins; low adherence to high-, moderate-, or low-intensity statins; and complete discontinuation of statin therapy (\u0026gt;\u200560 days with no statin supply and no prescription refills).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOutcomes included recurrent MI, hospitalization for cardiovascular diseases (CVD) and non-CVD, and all-cause mortality beginning 182 days after discharge and ending on December 31, 2012.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe majority of the 45\u2005629 individuals displayed high adherence to high-intensity statin therapy at 182 days (57.4%), followed by those whose adherence was low (18.8%), those who discontinued therapy (14.1%), and those with high adherence to a down-titrated regimen (9.7%). These groups were similar in age (mean age, 76 years), sex (female, 53%), and race (white, \u0026gt;\u200580%).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ESimilarities extended to the prevalence of diabetes (44.6%, 49.4%, 45.7%, and 43.3% in the same respective order) and a history of coronary heart disease (58.7%, 64.7%, 59.1%, and 54.8% in the same respective order).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ERecurrent MI within 182 days following hospital discharge occurred in 1324 (5.1%) patients with high adherence to high-intensity statins, 334 (7.5%) patients with high adherence to low- or moderate-intensity statins, 796 (9.3%) patients with low adherence to statins, and 484 (7.6%) patients who discontinued statins.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EPatients with high adherence to either high-intensity statins or low-\/moderate-intensity statins experienced fewer MI recurrences, fewer CVD-related hospitalizations, and fewer all-cause mortalitites. The pattern was less clear for non-CVD hospitalization but still favored high-adherent individuals.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAnalyses of results adjusting for calendar year, age, race\/ethnicity, and sex and for these parameters plus a battery of factors concerning patient care and history of comorbidities confirmed the lower occurrence of recurrent MI, CVD hospitalization, non-CVD hospitalization, and all-cause mortality in individuals with high adherence, be that to low-, moderate-, or high-intensity statins. Individuals whose adherence was low or who discontinued statin use had worse outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThus, down-titration and discontinuation of high-intensity statins are both common and detrimental.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/28_suppl_1\/8.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlfwp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}