Evaluating Adherence to Concomitant Diabetes, Hypertension, and Hyperlipidemia Treatments and Cardiovascular Outcomes Among Elderly Patients Using Marginal Structural Modeling

• Published in: High blood pressure & cardiovascular prevention Vol. 29; no. 6; pp. 601 - 610
• Main Authors: Paranjpe, R, Johnson, M. L, Chen, H, Birtcher, K, Serna, O, Mohan, A, Abughosh, Susan
• Format: Journal Article
• Language: English
• Published: Auckland Springer Nature B.V 01.11.2022
• Subjects: Antidiabetics; Antihypertensives; Cardiovascular disease; Chronic illnesses; Clinical outcomes; Comorbidity; Diabetes; Hyperlipidemia; Hypertension; Lipids; Medicaid; Medicare; Older people; Patient compliance; Pharmacy; Regression analysis; Statins; Subsidies; Therapy; Variables
• ISSN: 1120-9879; 1179-1985
• DOI: 10.1007/s40292-022-00543-4

IntroductionComorbid diabetes, hypertension, and hyperlipidemia is associated with an adverse effect on cardiovascular (CV) outcomes. Adherence to concurrent anti-diabetics, anti-hypertensives, and lipid-lowering therapies is essential to achieve therapeutic benefits.AimThe objective was to evaluate the association between adherence to concomitant oral antidiabetics, statins, and RAS antagonists (triple therapy) and CV outcomes, among elderly patients using marginal structural modeling (MSM).MethodsA retrospective study was conducted among patients on concurrent triple therapy from January 2016 until December 2019. Adherence to concurrent triple therapy was measured every 6 months using proportion of days covered (PDC) to determine the different adherence groups. CV outcomes were also measured every 6 months. A MSM controlling for baseline covariates and time-varying confounders affected by prior adherence was conducted to evaluate the association between adherence and CV outcomes. A sub-analysis was conducted among patients with prior CV events to evaluate the association between adherence to triple therapy and CV outcomes using MSMs.ResultsThe final cohort comprised of 7433 patients. The MSM model revealed no significant associations between adherence to triple/double therapies and cardiovascular outcomes. For sub-analysis, 471 patients with a prior CV event were identified. Results of the sub-analysis revealed no significant associations between adherence to triple/double therapies and CV outcomes among patients with prior CV events.ConclusionFuture studies should evaluate the association with longer follow-up periods.