Impact of adherence to statins on coronary artery disease in primary prevention
Bibliographic record
Abstract
What is already known about this subject • There is a major gap between the use of statins in clinical trial settings and in actual practice. • Unfortunately, little is known about the impact of suboptimal use of statins on clinical outcomes. What this study adds • Patients who filled more than 90% of the prescribed doses began to achieve significant reductions in nonfatal coronary artery disease events. • Statin effectiveness is apparent after one full year of treatment. Aims To evaluate the impact of adherence to statins on nonfatal coronary artery disease (CAD). Statins reduce cardiovascular morbidity and mortality after 1–2 years of continuous treatment. Studies have shown that <40% of patients take ≥80% of prescribed doses 1 year after starting therapy and that approximately half discontinue medication within 6 months of starting therapy. Methods A cohort of 20 543 patients was reconstructed using the Régie de l'assurance maladie du Québec databases. Patients aged 50–64 years, without cardiovascular disease, and newly treated with statins between 1998 and 2000 were eligible. A nested case–control design was used to study nonfatal CAD. Every case was matched with 20 randomly selected controls. The adherence level was defined as the percentage of the prescribed medication doses used over a specified period and classified as ≥90% or <90%. Rate ratios (RR) of nonfatal CAD were determined through conditional logistic regression adjusted for age, sex, socioeconomic status, diabetes and hypertension. Results The mean patient age was 58 years, 45% had hypertension and 19% had diabetes. Men represented 37% of the cohort. Among patients followed for >1 year, adherence of ≥90% was associated with fewer nonfatal CAD events (RR 0.81; 0.67, 0.97) compared with adherence <90%. In the multivariate model, male gender (RR 1.37; 1.16, 1.63), welfare recipients (RR 1.24; 1.04, 1.48), newly diagnosed hypertension (RR 3.54; 2.62, 4.77) and newly diagnosed diabetes mellitus (RR 1.97; 1.20, 3.24) were risk factors for CAD. Conclusion The incidence of nonfatal CAD events decreases when >90% of the prescribed medications is used over at least 1 year.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.031 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".