Another treatment gap: Restarting secondary prevention medications: The Women's Health Initiative

Robinson, Jennifer G.; Wallace, Robert; Safford, Monika M.; Pettinger, Mary; Cochrane, Barbara; Ko, Marcia G.; O'Sullivan, Mary Jo; Masaki, Kamal; Petrovich, Helen

doi:10.1016/j.jacl.2009.12.006

« Previous Next »Journal of Clinical Lipidology
Volume 4, Issue 1 , Pages 36-45, January 2010

Another treatment gap: Restarting secondary prevention medications: The Women's Health Initiative

Jennifer G. Robinson, MD, MPH
- Department of Medicine, 200 Hawkins Drive SE 21C GH, University of Iowa, Iowa City, IA 52242 USA
- Department of Epidemiology, 200 Hawkins Drive SE 21C GH, University of Iowa, Iowa City, IA 52242 USA
- Corresponding author.
Robert Wallace, MD
- Department of Epidemiology, 200 Hawkins Drive SE 21C GH, University of Iowa, Iowa City, IA 52242 USA
Monika M. Safford, MD
- Deep South Center on Effectiveness at the Birmingham VA Medical Center and the University of Alabama, Birmingham, AL, USA
Mary Pettinger, MS
- Fred Hutchinson Cancer Center, Seattle, WA, USA
Barbara Cochrane, PhD, RN
- University of Washington, Seattle, WA, USA
Marcia G. Ko, MD
- Division of Women's Health, Mayo Clinic, Scottsdale, AZ, USA
Mary Jo O'Sullivan, MD
- University of Miami, Miller School of Medicine, Miami, FL, USA
Kamal Masaki, MD
- Department of Geriatric Medicine, University of Hawaii, Manoa, HI
- John A. Burns School of Medicine and School of Public Health, University of Hawaii, Manoa, HI; for the Women's Health Initiative Investigators
Helen Petrovich, MD
- John A. Burns School of Medicine and School of Public Health, University of Hawaii, Manoa, HI; for the Women's Health Initiative Investigators

Received 6 November 2009; accepted 18 December 2009. published online 28 December 2009.

Background

Women's long-term patterns of evidence-based preventive medication use after a diagnosis of coronary heart disease have not been sufficiently studied.

Methods

Postmenopausal women ages 50 to 79 years were eligible for randomization in the Women's Health Initiative's hormone trials if they met inclusion and exclusion criteria and were >80% adherent during a placebo-lead-in period and in the dietary modification trial if they were willing to follow a 20% fat diet. Those with adjudicated myocardial infarction or coronary revascularization after the baseline visit were included in the analysis (n = 2627). Baseline visits occurred between 1993 and 1998, then annually until the trials ended in 2002 through 2005; medication inventories were obtained at baseline and years 1, 3, 6, and 9.

Results

Use at the first Women's Health Initiative visit after a coronary heart disease diagnosis increased over time for statins (49% to 72%; P < .0001), beta-blockers (49% to 62%; P = .003), and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEI/ARBs; 26%-43%; P < .0001). Aspirin use remained stable at 76% (P = .09). Once women reported using a statin, aspirin, or beta-blocker, 84% to 89% reported use at 1 or more subsequent visits, with slightly lower rates for ACEI/ARBS (76%). Statin, aspirin, beta-blocker, or ACEI/ARB use was reported at 2 or more consecutive visits by 57%, 66%, 48%, and 28%, respectively. These drugs were initiated or resumed at a later visit by 24%, 17%, 15%, and 17%, respectively, and were never used during the period of follow-up by 19%, 10%, 33%, and 49% respectively.

Conclusions

Efforts to improve secondary prevention medication use should target both drug initiation and restarting drugs in patients who have discontinued them.

Keywords: Adherence, Coronary heart disease, Secondary prevention, Statins, Women