Change in Trajectories of Adherence to Lipid-Lowering Drugs Following Non-Fatal Acute Coronary Syndrome or Stroke

J Am Heart Assoc. 2019 Dec 3;8(23):e013857. doi: 10.1161/JAHA.119.013857. Epub 2019 Nov 27.


Background Poor adherence to cardioprotective drugs remains a concern among patients for secondary prevention. A better understanding of adherence fluctuations before and after critical health events may inform approaches for addressing or preventing poor adherence. Therefore, we assessed trajectories of adherence to lipid-lowering drugs before and after acute coronary syndrome (ACS) or stroke and identified post-ACS/stroke trajectories' predictors. Methods and Results We conducted a cohort study of patients hospitalized for ACS or stroke in Alberta, Canada, using administrative health data between 2009 and 2015. Patients using lipid-lowering drugs in the 2 years pre-hospitalization and had post-discharge follow-up ≥365 days were included. We used group-based trajectory modeling to assess adherence trajectories and multinomial logistic regression to assess trajectories' predictors. In total, 10 623 patients were included. The average age was 69 years, and 65% were men. Five trajectories were identified in both periods: nearly perfect, gradual increase, gradual decline, rapid decline, and poor adherence throughout. Of patients who were poor adherers, rapidly or gradually declining pre-hospitalization, 2395/3588 (66.8%) switched to gradual increase or perfect adherence post discharge. Conversely, of patients gradually increasing or nearly perfect before, only 4822/7035 (68.5%) were nearly perfect adherers after. Main predictors of poor post-ACS/stroke trajectories included older age, female sex, lack of immediate post discharge follow-up, and prior trajectories. Conclusions This study suggests that adherence post-ACS/stroke is highly variable and emphasizes the importance for clinicians to recognize that post-discharge adherence will likely change negatively for prior good adherers. Adherence-enhancing interventions should occur both early and late following discharge.

Keywords: acute coronary syndrome; adherence trajectories; lipid‐lowering drugs; pre‐post hospitalization; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome*
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Hypolipidemic Agents / therapeutic use*
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Stroke*


  • Hypolipidemic Agents