Adherence with cardiovascular medications and the outcomes in patients with coronary arterial disease: “Real‐world” evidence

Background Cardiovascular medications are vital for the secondary prevention of coronary arterial disease (CAD). However, the effect of cardiovascular medication may depend on the optimal adherence of the patients. This meta‐analysis aims to determine the magnitude of adherence to vascular medicatio...

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Veröffentlicht in:Clinical cardiology (Mahwah, N.J.) Jg. 45; H. 12; S. 1220 - 1228
Hauptverfasser: Chen, Chen, Li, Xiaoqing, Su, Yuhao, You, Zhigang, Wan, Rong, Hong, Kui
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States John Wiley & Sons, Inc 01.12.2022
John Wiley and Sons Inc
Schlagworte:
ACEI/ARB
Acute coronary syndromes
Analysis
Angiotensin converting enzyme
Angiotensin Receptor Antagonists - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Aspirin
Beta blockers
beta‐blocker
Cardiac patients
Cardiovascular Agents - adverse effects
Cardiovascular disease
Cardiovascular Diseases
Chronic illnesses
Chronic obstructive pulmonary disease
Clinical Investigations
Coronary Artery Disease - drug therapy
coronary heart disease
Coronary vessels
Diabetes
Disease prevention
dose–response
Drug therapy
Enzymes
Heart attacks
Heart failure
Hospitals
Humans
medication adherence
Meta-analysis
Mortality
Patient compliance
Patient outcomes
Prospective Studies
risk factor
statin
Statins
Canada
United Kingdom > UK
United States > US
China
Finland
Italy
Israel
beta-blocker
statin
dose-response
coronary heart disease
medication adherence
risk factor
ACEI/ARB
ISSN:0160-9289, 1932-8737, 1932-8737
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Zusammenfassung:Background Cardiovascular medications are vital for the secondary prevention of coronary arterial disease (CAD). However, the effect of cardiovascular medication may depend on the optimal adherence of the patients. This meta‐analysis aims to determine the magnitude of adherence to vascular medications that influences the absolute and relative risks (RRs) of mortality in patients with CAD in real‐world settings. Methods The Cochrane Library, PubMed, and EMBASE databases were searched through March 1, 2022. Prospective studies reporting association as RR and 95% confidence interval between cardiovascular medication adherence and any cardiovascular events and/or all‐cause mortality in patients with CAD were included. A one‐stage robust error meta‐regression method was used to summarize the dose‐specific relationships. Results A total of 18 studies were included. There is a significant inverse linear association between cardiovascular medication adherence and cardiovascular events (pnonlinearity = .68) or mortality (pnonlinearity = .82). The exposure‐effect analysis showed that an improvement of 20% cardiovascular medication adherence was associated with 8% or 12% lower risk of any cardiovascular events or mortality, respectively. In subgroup analysis, the benefit was observed in adherence of stain (RR: 0.90, for cardiovascular events, RR: 0.85, for mortality), angiotensin‐converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB)(RR: 0.90, for mortality), and antiplatelet agent (RR: 0.89 for mortality) but not in beta‐blocker (RR: 0.90, p = .14, for cardiovascular events, RR: 0.97, p = .32 for mortality). Estimated absolute differences per 1 million individuals per year for mortality associated with 20% improvement were 175 cases for statin, 129 cases for antiplatelet, and 117 cases for ACEI/ARB. Conclusion Evidence from the real word showed poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease events and mortality in patients with CAD.
Bibliographie:Chen Chen and Xiaoqing Li are co‐first authors.
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ISSN:0160-9289
1932-8737
1932-8737
DOI:10.1002/clc.23898