The effectiveness of lipid-lowering therapy (LLT) for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in routine care may depend on treatment intensity and adherence. Observational study of adults with newly initiated LLT for primary prevention of ASCVD in Stockholm, Sweden, during 2017-2021. Study exposures were LLT adherence [proportion of days covered (PDC)], LLT intensity (expected reduction of LDL cholesterol), and the combined measure of adherence and intensity. At each LLT fill, adherence and intensity were calculated during the previous 12 months, and the patients estimated ASCVD risk was categorized. Study outcomes were major adverse cardiovascular events (MACE) and LDL-C goal attainment. Thirty-six thousand two hundred eighty-three individuals (mean age 63 years, 47% women, median follow-up 2 years), with a baseline low-moderate (40%), high (49%), and very-high (11%) ASCVD risk started LLT. Increases in LLT adherence, intensity, or adherence-adjusted intensity of 10% over 1 year were associated with lower risks of MACE (with hazard ratios of 0.95 [95% CI, 0.93-0.98]; 0.93 [0.86-1.00]; and 0.90 [0.85-0.95], respectively) and higher odds of attaining LDL goals. Patients with good adherence (≥80%) had similar risks of MACE and similar odds ratios for LDL-C goal attainment with low-moderate and high-intensity LLT. Treatment discontinuation was associated with increased MACE risk. The relative and absolute benefits of good adherence were greatest in patients with very high ASCVD risk. In routine-care primary prevention, better adherence to LLT was associated with a lower risk of MACE across all treatment intensities. Improving adherence is especially important among patients with very high ASCVD risk.

中文翻译：

---

降脂治疗的强度和依从性作为一级预防中目标实现和主要不良心血管事件的预测因素

在常规护理中，降脂治疗 (LLT) 对动脉粥样硬化性心血管疾病 (ASCVD) 一级预防的有效性可能取决于治疗强度和依从性。 2017-2021 年在瑞典斯德哥尔摩针对 ASCVD 一级预防新启动 LLT 的成人的观察性研究。研究暴露的是 LLT 依从性 [覆盖天数比例 (PDC)]、LLT 强度（LDL 胆固醇的预期降低）以及依从性和强度的综合测量。每次 LLT 填充时，都会计算前 12 个月内的依从性和强度，并对患者估计的 ASCVD 风险进行分类。研究结果是主要不良心血管事件 (MACE) 和 LDL-C 目标达到情况。 36,283 人（平均年龄 63 岁，47% 为女性，中位随访时间为 2 年），基线为低-中 (40%)、高 (49%) 和极高 ( 11%) ASCVD 风险开始 LLT。一年内 LLT 依从性、强度或依从调整强度增加 10% 与 MACE 风险降低相关（风险比为 0.95 [95% CI，0.93-0.98]；0.93 [0.86-1.00]；和 0.90） [0.85-0.95]，分别），并且达到 LDL 目标的几率更高。依从性良好 (≥80%) 的患者在低中度和高强度 LLT 中发生 MACE 的风险相似，LDL-C 目标达到的比值比也相似。治疗停止与 MACE 风险增加相关。对于 ASCVD 风险极高的患者，良好依从性的相对和绝对益处最大。在常规护理一级预防中，更好地坚持 LLT 与所有治疗强度中较低的 MACE 风险相关。提高依从性对于 ASCVD 风险极高的患者尤其重要。