ARYA Atherosclerosis Journal

Association between statin intensity and adherence, and MACE in post- STEMI patients: A cohort study

Document Type : Original Article

Authors

Masoumeh Sadeghi 1
Mohadeseh Arefian 2
Elham Ramezannezhad 2
Amirhossein Ebrahimi 2
Kiarash kavianian 2
Safoura Yazdekhasti 1
Zahra Teimouri-Jervekani 1
Hamidreza Roohafza 3

1 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

https://doi.org/10.48305/arya.2026.46165.3145
Abstract
BACKGROUND: Statins are among secondary preventive cardiovascular medications that adherence is critical to their effectiveness. Although, the management of cardiovascular diseases emphasize both intensity and patient adherence, observations show that statin adherence and intensity is not adequate. This study aimed to measure statin adherence and intensity in post-ST elevated myocardial infarction patients and its association with major adverse cardiovascular events (MACE).
METHODS: Of 867 patients in the ST-elevated myocardial infarction cohort study in Isfahan, 549 individuals had data on the intensity of statin therapy. 455 of these patients tended to fill out the adherence questionnaire. Morisky Medication Adherence questionnaire and a checklist consisting potential adherence, and intensity-associated factors were filled out.
RESULTS: In the age group of 50-70 years, increasing age (P = 0.014), receiving physician's support on the consequences of statin discontinuation (P = 0.019), taking lower number of medications (P = 0.045) were significantly associated with statin adherence. Besides, the experience of side effects (P = 0.028) and depressed mood (P ≤ 0.0001) were negatively associated with adherence. None of the measured factors were associated with statin intensity. Statin adherence and statin intensity independently affect MACE, such that even after full adjustment, the chance of experiencing MACE increases 8% (95% CI = 1.02, 1.20) for low-statin adherents and 12% (1.04, 1.28) for patients on non-high statin intensity.
CONCLUSION: Statins have a significant role in the prediction of MACE, based on their intensity and adherence. Educational support from the physician, considering patients' mood and number of medications could improve patients' adherence.

Keywords

Statins
Adherence
Statin Intensity
Myocardial Infarction
Major Adverse Cardiovascular Events
1. Pina IL, Di Palo KE, Brown MT, Choudhry NK, Cvengros J, Whalen D, et al. Medication adherence: importance, issues and policy: a policy statement from the American Heart Association. Prog Cardiovasc Dis. 2021;64:111-120. https://doi.org/10.1016/j.pcad.2020.08.003
2. Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015;17(2):e52. https://doi.org/10.2196/jmir.3951
3. Newman CB, Preiss D, Tobert JA, Jacobson TA, Page RL, Goldstein LB, et al. Statin safety and associated adverse events: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2019;39(2):e38-e81. https://doi.org/10.1161/ATV.0000000000000081
4. Ingersgaard MV, Helms Andersen T, Norgaard O, Grabowski D, Olesen K. Reasons for nonadherence to statins-a systematic review of reviews. Patient Prefer Adherence. 2020;14:675-691. https://doi.org/10.2147/PPA.S245365
5. Ofori-Asenso R, Jakhu A, Curtis AJ, Zomer E, Gambhir M, Jaana Korhonen M, et al. A systematic review and meta-analysis of the factors associated with nonadherence and discontinuation of statins among people aged ≥65 years. J Gerontol A Biol Sci Med Sci. 2018;73(6):798-805. https://doi.org/10.1093/gerona/glx256
6. Lansberg P, Lee A, Lee ZV, Subramaniam K, Setia S. Nonadherence to statins: individualized intervention strategies outside the pill box. Vasc Health Risk Manag. 2018;14:91-102. https://doi.org/10.2147/VHRM.S158641
7. Chen PS, Lin SH, Lee CH, Lin HW, Li YH. Efficacy and safety of high-intensity statins in patients with acute myocardial infarction: an Asian perspective. Can J Cardiol. 2020;36(6):886-892. https://doi.org/10.1016/j.cjca.2019.10.027
8. Virani SS, Smith SC Jr, Stone NJ, Grundy SM. Secondary prevention for atherosclerotic cardiovascular disease: comparing recent US and European guidelines on dyslipidemia. Circulation. 2020;141(14):1121-1123. https://doi.org/10.1161/CIRCULATIONAHA.119.044282
9. Steen DL, Khan I, Becker L, Foody JM, Gorcyca K, Sanchez RJ, et al. Patterns and predictors of lipid-lowering therapy in patients with atherosclerotic cardiovascular disease and/or diabetes mellitus in 2014: insights from a large US managed-care population. Clin Cardiol. 2017;40(3):155-162. https://doi.org/10.1002/clc.22641
10. Wang WT, Hellkamp A, Doll JA, Thomas L, Navar AM, Fonarow GC, et al. Lipid testing and statin dosing after acute myocardial infarction. J Am Heart Assoc. 2018;7(3):e006460. https://doi.org/10.1161/JAHA.117.006460
11. Yu S, Jin J, Chen Z, Luo X. High-intensity statin therapy yields better outcomes in acute coronary syndrome patients: a meta-analysis involving 26,497 patients. Lipids Health Dis. 2020;19(1):194. https://doi.org/10.1186/s12944-020-01369-6
12. Sadeghi M, Soleimani A, Sarrafzadegan N, Askari M, Nouri F, Masoumi G, et al. Background and design of a 5-year ST Elevation Myocardial Infarction Cohort in Isfahan, Iran: SEMI-CI study. ARYA Atheroscler. 2021;17(3):1-8.
13. Dehghan M, Dehghan-Nayeri N, Iranmanesh S. Translation and validation of the Persian version of the treatment adherence questionnaire for patients with hypertension. ARYA Atheroscler. 2016;12(2):76-82.
14. Mu Y, Feng L, Taitel M. PMU127 Diabetes, Hypertension, and Statin Medication Adherence and Depression. Value Health. 2020;23(Suppl 1):S257. https://doi.org/10.1016/j.jval.2020.04.890
15. Gureje O, Oladeji BD, Montgomery AA, Araya R, Bello T, Chisholm D, et al. High-versus low-intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: cluster randomised controlled trial (the EXPONATE trial). Br J Psychiatry. 2019;215(3):528-535. https://doi.org/10.1192/bjp.2019.4
16. Nelson AJ, Puri R, Nissen SE. Statins in a Distorted Mirror of Media. Curr Atheroscler Rep. 2020;22(8):37. https://doi.org/10.1007/s11883-020-00853-9
17. Rosenson RS, Kent ST, Brown TM, Farkouh ME, Levitan EB, Yun H, et al. Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease. J Am Coll Cardiol. 2015;65(3):270-277. https://doi.org/10.1016/j.jacc.2014.09.088
18. Penson PE, Mancini GBJ, Toth PP, Martin SS, Watts GF, Sahebkar A, et al. Introducing the ‘Drucebo’ effect in statin therapy: a systematic review of studies comparing reported rates of statin-associated muscle symptoms, under blinded and open-label conditions. J Cachexia Sarcopenia Muscle. 2018;9(6):1023-1033. https://doi.org/10.1002/jcsm.12344
19. Katzmann JL, Mahfoud F, Böhm M, Schulz M, Laufs U. Association of medication adherence and depression with the control of low-density lipoprotein cholesterol and blood pressure in patients at high cardiovascular risk. Patient Prefer Adherence. 2019;13:9-19. https://doi.org/10.2147/PPA.S182765
20. Ahrens I, Khachatryan A, Monga B, Dornstauder E, Sidelnikov E. Association of Treatment Intensity and Adherence to Lipid-Lowering Therapy with Major Adverse Cardiovascular Events Among Post-MI Patients in Germany. Adv Ther. 2021;38(5):2532-2541. https://doi.org/10.1007/s12325-021-01697-8
21. Bansilal S, Castellano JM, Garrido E, Wei HG, Freeman A, Spettell C, et al. Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes. J Am Coll Cardiol. 2016;68(8):789-801. https://doi.org/10.1016/j.jacc.2016.06.005
22. Xie G, Sun Y, Myint PK, Patel A, Yang X, Li M, et al. Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes. Lipids Health Dis. 2017;16(1):155. https://doi.org/10.1186/s12944-017-0544-0
23. Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333(7557):15. https://doi.org/10.1136/bmj.38875.675486.55
24. Chaure-Pardos A, Malo S, Rabanaque MJ, Arribas F, Moreno-Franco B, Aguilar-Palacio I. Factors Associated with the Prescribing of High-Intensity Statins. J Clin Med. 2020;9(12):3850. https://doi.org/10.3390/jcm9123850
25. Rosenson RS, Farkouh ME, Mefford M, Bittner V, Brown TM, Taylor B, et al. Trends in Use of High-Intensity Statin Therapy After Myocardial Infarction, 2011 to 2014. J Am Coll Cardiol. 2017;69(22):2696-2706. https://doi.org/10.1016/j.jacc.2017.03.585
26. Peters SAE, Colantonio LD, Zhao H, Bittner V, Dai Y, Farkouh ME, et al. Sex Differences in High-Intensity Statin Use Following Myocardial Infarction in the United States. J Am Coll Cardiol. 2018;71(16):1729-1737. https://doi.org/10.1016/j.jacc.2018.02.032
ARYA Atherosclerosis Journal
Volume 22, Issue 4
July and August 2026
Pages 42-52

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us