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Comment & Response
June 26, 2019

Studies Evaluating Statin Adherence and Outcome Should Adjust for Smoking Persistence and Antiplatelet Treatment Discontinuation

Author Affiliations
  • 1Service de cardiologie, Centre Hospitalier Régional Universitaire de Grenoble-Alpes, Grenoble, France
  • 2Departement Public Health, Medizinische Fakultät, Universität Basel, Basel, Switzerland
  • 3Cardiology Department, Groupement des hôpitaux de l’institut Catholique de Lille, Université Catholique de Lille, Lille, France
JAMA Cardiol. Published online June 26, 2019. doi:10.1001/jamacardio.2019.1966

To the Editor We read with interest the recent article by Rodriguez et al1 about the association of statin adherence with all-cause mortality in a retrospective cohort study of outpatients with established atherosclerotic cardiovascular disease (ASCVD). The authors state that, after multivariable adjustment, adherence levels were significantly associated with 1-year mortality. Surprisingly, tobacco use and other major ASCVD medications, including antiplatelet therapy, were not reported in the analysis or discussed, while the mortality benefit of systematic β-adrenergic blockade therapy is less documented in patients with ASCVD. It seems necessary to adjust for the above-mentioned variables, as antiplatelet treatment compliance and smoking persistence are major cardiovascular risk factors. Use of antiplatelet therapy consistently reduces recurrent acute cardiovascular events in patients with established ASCVD.2,3 Moreover, smoking cessation is responsible for an approximately one-third reduction in mortality compared with persistent smokers.4 Conversely, data from the Organization to Assess Strategies in Acute Ischemic Syndromes trial5 showed that persistent smokers who also did not modify diet or exercise had a nearly 4-fold risk of a repeated cardiovascular event. In conclusion, we would like to bring to the authors’ attention that it might be interesting and worthwhile to adjust for additional risk factors if the data are available to them or to possibly discuss why these were not included in their article.