Association of Diabetes Mellitus Status and Glycemic Control With Secondary Prevention Medication Adherence After Acute Myocardial Infarction.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE

Original Publication: Oxford : Wiley-Blackwell

Adrenergic beta-Antagonists/*therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/*therapeutic use ; Blood Glucose/*metabolism ; Diabetes Mellitus, Type 2/*drug therapy ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Myocardial Infarction/*drug therapy ; Secondary Prevention/*methods; Age Factors ; Aged ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/complications ; Female ; Follow-Up Studies ; Humans ; Male ; Medication Adherence ; Myocardial Infarction/etiology ; Myocardial Infarction/mortality ; Prognosis ; Retrospective Studies ; Survival Rate/trends ; United States/epidemiology

Background Cardioprotective medication adherence can mitigate the risk of recurrent cardiovascular events and mortality after acute myocardial infarction ( AMI ). We examined the associations of diabetes mellitus status and glycemic control with cardioprotective medication adherence after AMI . Methods and Results We performed a retrospective observational cohort study of 14 517 US veterans who were hospitalized for their first AMI between 2011 and 2014 and prescribed a beta-blocker, 3-hydroxy-3-methyl-glutaryl-CoA-reductase inhibitor, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The primary exposure was a diagnosis of type 2 diabetes mellitus; in diabetes mellitus patients, hemoglobin A1c (HbA1c) was a secondary exposure. The primary outcome was 1-year adherence to all 3 medication classes, defined as proportion of days covered ≥0.8, assessed using adjusted risk differences and multivariable Poisson regression. Of 14 517 patients (mean age, 66.3 years; 98% male), 52% had diabetes mellitus; 9%, 31%, 24%, 15%, and 21% had HbA1c <6%, 6% to 6.9%, 7% to 7.9%, 8% to 8.9%, and ≥9%, respectively. Diabetes mellitus patients were more likely to be adherent to all 3 drug classes than those without diabetes mellitus (adjusted difference in adherence, 2.1% [0.5, 3.7]). Relative to those with HbA1c 6% to 6.9%, medication adherence declined with increasing HbA1c (risk ratio of achieving proportion of days covered ≥0.8, 0.99 [0.94, 1.04], 0.93 [0.87, 0.99], 0.82 [0.77, 0.88] for HbA1c 7-7.9%, 8-8.9%, and ≥9%, respectively). Conclusions Although diabetes mellitus status had a minor positive impact on cardioprotective medication adherence after AMI , glycemic control at the time of AMI may help identify diabetes mellitus patients at risk of medication nonadherence who may benefit from adherence interventions after AMI .

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Keywords: diabetes mellitus; medication adherence; myocardial infarction

0 (Adrenergic beta-Antagonists)
0 (Angiotensin-Converting Enzyme Inhibitors)
0 (Blood Glucose)
0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)

Date Created: 20190205 Date Completed: 20200224 Latest Revision: 20210109

20221213

PMC6405589

10.1161/JAHA.118.011448

30712488