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Dyslipidemia and Concurrent Medications Improve Likelihood of Persistence to ACE Inhibitor Therapy: Presented at CCC

By Danny Kucharsky

MONTREAL, CANADA -- October 27, 2005 -- Persistence to therapy with angiotensin-converting enzyme (ACE) inhibitors declines rapidly over an 18-month period, according to preliminary results of a study presented here at the Canadian Cardiovascular Society Congress 2005 (CCC).

The study also found the decline in persistence differs depending on the ACE inhibitor the patient is taking.

Lead investigator Amede Gogovor, a Masters of Science in Drug Development student, faculty of pharmacy, University of Montreal, Montreal, Quebec, Canada, presented the study findings here on October 25^th. The study examined 4596 patients taking ACE inhibitors for primary prevention and 1621 taking ACE inhibitors for secondary prevention.

The study took a retrospective cohort of patients from the database of the Quebec government's medicare program. Patients were new users of ACE inhibitors who began taking the study medications between January 1998 and December 2000. They were followed for 18 months.

At 12 months, the persistence rate had decreased to below 70% among those in the secondary prevention cohort. "The rate of persistence declined quickly over 18 months' follow-up," Mr. Gogovor said.

Preliminary results show that persistence rates were higher among patients taking ramipril compared with other ACE inhibitors. At 18 months, among patients in the primary prevention cohort, persistence rates were 57% for patients taking ramipril, 54% for those on fosinopril, 48% for quinapril, 47% for lisinopril, and 45% for enalapril. In the secondary prevention cohort, the persistence rates were 62%, 53%, 52%, 50%, and 47%, respectively.

The adjusted rate ratio of therapy discontinuation was consistently higher for all other ACE inhibitors relative to ramipril. Differences were statistically significant in the primary prevention cohort with lisinopril (RR: 1.34, 1.18-1.52), quinapril (RR: 1.35, 1.18-1.54), and enalapril (RR: 1.46, 1.27-1.68). In the secondary prevention cohort, differences were statistically significant with lisinopril (RR: 1.30, 1.06-1.61) and enalapril (RR: 1.38, 1.10-1.72).

Dyslipidemia was a significant predictor of persistence with ACE inhibitor therapy. The concurrent use of other medications also appears to improve the likelihood of persistence. However, demographic characteristics did not predict persistence to therapy.

Mr. Gogovor said a second phase of the study, involving patient interviews, will attempt to find out why people stop taking the drugs and seek ways to improve compliance.


[Presentation title: Preliminary Results of an Analysis of Persistence to Therapy Among Patients Taking Angiotensin-Converting Enzyme Inhibitors for Primary and Secondary Prevention. Abstract 784]

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