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Adherence to lipid-lowering therapy and risk for cardiovascular disease and death in type 1 diabetes mellitus: A population-based study from the Swedish National Diabetes Register

Artikel i vetenskaplig tidskrift
Författare Christel Hero
Sofia A. Karlsson
Stefan Franzén
Ann-Marie Svensson
Mervete Miftaraj
Soffia Gudbjörnsdottir
Karolina Andersson Sundell
Björn Eliasson
Katarina Eeg-Olofsson
Publicerad i BMJ Open Diabetes Research and Care
Volym 8
Nummer/häfte 1
ISSN 2052-4897
Publiceringsår 2020
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
Institutionen för medicin
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Språk en
Länkar dx.doi.org/10.1136/bmjdrc-2019-0007...
Ämnesord adherence to medications, cardiac risk reduction, insulin-deficient Type 1 diabetes, lipid-lowering drugs/medication
Ämneskategorier Epidemiologi, Kardiovaskulär medicin, Endokrinologi och diabetes

Sammanfattning

Aims/hypothesis Dyslipidemia is an important modifiable risk factor and lipid-lowering treatment (LLT) is essential to reduce the risk of cardiovascular disease (CVD). Studies in type 2 diabetes indicate that low adherence to statin therapy is a barrier to reach full protective potential, and less is known in type 1 diabetes (T1D). The aim was to assessrisk of CVD by adherence and nonpersistence to LLT in T1D. Method A population-based study with a retrospective longitudinal design was conducted between 2006 and 2010, with follow-up until December 2013. In total, 6192 adult individuals withT1D, initiatingLLTbetween 2006 and 2010, were included.Information on LLT, socioeconomic characteristics, comorbidities and cardiovascular eventswere collected. After 18 months, refill adherence was estimated by calculating medication possession ratio (MPR). Nonpersistence was defined as being without medicines on hand for at least 180 days. Individuals were thereafterfollowed untilCVD, deathorend of follow-up in December 2013. Cox regression analyses were performed to assess adherence level and nonpersistence of LLT as predictor ofCVD. Analyses wereadjusted for cardiovascular risk factors andsocioeconomic status. Results Mean MPRwas 72%, 52% of the participants had an MPR above 80% and 27% discontinued LLT. There were 637nonfataland58 fatal CVDevents, mean follow-up 3.6 and 3.9 years, respectively. MPR above 80% was associated with reduced risk for nonfatal CVD compared with lower MPR, HR 0.78 (95% CI 0.65 to 0.93)). For fatal CVD, results indicated a negative effect of high adherence but the association did not reach statistical significance, HR 1.96 (0.96 to 4.01). Individuals discontinuing LLT had higher risk of nonfatal CVD, HR 1.43 (95% CI 1.18 to 1.73). Conclusions/Interpretation In T1D, the risk for nonfatal CVD was lower among individuals with high adherence and higher among those discontinuing LLT within 18 months. It is important to evaluate andemphasize adherence toprescribedLLTat clinical visits to achieve treatment goals and reduce the risk of CVD. © Author(s) (or their employer(s)) 2020.

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