Medication adherence to lipid-lowering agents after percutaneous coronary intervention: nationwide real-world data in the Netherlands

BACKGROUND: Lipid-lowering medication reduces the risk of future cardiovascular events and mortality, yet adherence is often disappointing. This study evaluates adherence rates of lipid-lowering medication and its subtypes during the first year following acute and elective percutaneous coronary intervention (PCI) in the Netherlands. METHODS: This retrospective cohort study utilized data from a nationwide all-payer claims database managed by Vektis, containing all medical care claims reimbursed by Dutch national insurance companies. We included 97,176 patients who underwent PCI in 2018-2020. Adherence was defined as a medication possession rate ≥ 80%. RESULTS: Adherence rates 0-3 months post-elective PCI ranged from 71-73% among the years and remained stable over the year following PCI. For acute PCI, adherence rates 0-3 months post-acute PCI were initially higher (79-81%) but declined to 74-76% during the year following PCI. During the year following PCI, adherence rates for ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors increased slightly to about 13%, respectively 2%, while statin adherence decreased. For statin subtypes, adherence rates for rosuvastatin increased at the expense of simvastatin, with adherence for atorvastatin and other statins remaining relatively stable. Lower adherence rates were observed among females and patients ≥ 80 years compared to males and younger patients. CONCLUSION: This study found lipid-lowering medication adherence 1 year post-elective PCI ranged from 71-73% and post-acute PCI from 74-76%. Lower adherence rates were observed in women and elderly patients. Adherence rates of ezetimibe and PCSK9 inhibitors increased throughout the year following PCI, while statin use decreased.