The COMPARATIVE ANALYSIS OF MEDICATION ADHERENCE AND OUTCOMES IN DIABETIC AND NON-DIABETIC PAKISTANI PATIENTS UNDERGOING CORONARY STENTING
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Keywords
Coronary artery disease, medication adherence, diabetic patients, coronary stenting, Pakistan, Clopidogrel, Aspirin.
Abstract
Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide, with a pronounced impact in countries like Pakistan where the burden of cardiovascular diseases is continuously rising. Effective post-procedural management, including medication adherence, is crucial in optimizing outcomes after coronary stenting, particularly in diabetic patients who are at an elevated risk for cardiovascular complications.
Methods: This prospective observational study was conducted at Lady Reading Hospital, Peshawar, from January 1st, 2020, to December 31st, 2021. It aimed to analyze and compare medication adherence and clinical outcomes between diabetic (DM) and non-diabetic (Non-DM) Pakistani patients undergoing coronary stenting. The primary outcome was medication adherence rates, while secondary outcomes included major adverse cardiovascular events (MACE), such as myocardial infarction, stroke, and death. Statistical analyses were performed using SPSS version 26.0.
Results: The study enrolled a total of 3,270 patients, equally divided between DM and Non-DM groups. Medication adherence was impressively high across both groups, with DM patients treated with Clopidogrel showing an adherence rate of 98.0%, slightly higher than the Aspirin group at 97.5%. In Non-DM patients, adherence rates were 98.5% for Clopidogrel and 97.8% for Aspirin. Clinical outcomes were strongly correlated with baseline medication use, and significant differences were noted in the efficacy of Clopidogrel over Aspirin, particularly in diabetic patients.
Discussion: The study confirms the superior efficacy of Clopidogrel over Aspirin in improving clinical outcomes and medication adherence, especially in diabetic patients. These findings suggest that tailored pharmacotherapy could significantly impact patient management post-stenting, advocating for personalized medication strategies based on diabetic status.
Conclusion: This research highlights the importance of medication adherence in managing post-stenting patients and underscores the need for personalized treatment approaches. Clopidogrel should be considered over Aspirin for diabetic patients to reduce the risk of adverse cardiovascular events effectively.
References
2. Brown K, Patel C. Importance of medication adherence in cardiovascular disease and the value of once-daily treatment regimens. Cardiol Ther. 2017;6(1):53-64.
3. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669-2701.
4. Lee CS, Tan JH, Sankari U, Koh YLE. Medication adherence in patients with diabetes and coronary artery disease: A systematic review. J Diabetes Complications. 2019;33(5):107418.
5. Patel T, Pancholy SB, Patel P. Effectiveness of Clopidogrel versus Aspirin in diabetic patients post-percutaneous coronary intervention: A meta-analysis of randomized trials. Am J Cardiol. 2020;125(7):985-992.
6. Malik M, Tahir MJ, Jabbar A. Challenges in the management of cardiovascular diseases in Pakistan and the impact of healthcare disparities. Pak Heart J. 2021;54(1):225-233.
7. Thompson A, Smith B. Tailored antiplatelet therapy: Maximizing benefits and minimizing risks. J Clin Pharmacol. 2020;60(7):845-856.
8. Khan AR, Riaz M, Bin Zafar MD. Overview of the use of personalized medicine in coronary artery disease: Focus on aspirin and clopidogrel resistance. Pak J Med Sci. 2021;37(2):605-610.
9. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354(16):1706-1717.
10. Angiolillo DJ, Bernardo E, Sabate M, et al. Impact of platelet reactivity on cardiovascular outcomes in patients with type 2 diabetes mellitus and coronary artery disease. J Am Coll Cardiol. 2007;50(16):1541-1547.
11. Sabate E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.
12. Pignone M, Alberts MJ, Colwell JA, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes. J Am Coll Cardiol. 2010;55(25):2878-2886.
13. Kang J, Park KW, Palmerini T, et al. Rationale and design of HOST-EXAM: a prospective, randomized, open-label, multicenter trial comparing clopidogrel vs aspirin monotherapy in patients who have successfully completed dual antiplatelet therapy after percutaneous coronary intervention. Am Heart J. 2020;220:79-86.
14. Cuisset T, Deharo P, Quilici J, et al. Benefit of switching dual antiplatelet therapy after acute coronary syndrome: The TOPIC randomized study. Eur Heart J. 2017;38(41):3070-3078.
15. CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329-1339.
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Fahad Raja khan
Cardiologist, Lady reading Hospital MTI Peshawar, Pakistan
Dr Shakeel Ahmed Memon
Assistant Professor of Cardiology, Lady reading Hospital MTI Peshawar, Pakistan, Email:
Dr Samra Rehmat
Assistant Professor and Consultant Interventional Cardiologist, Lady reading Hospital MTI Peshawar, Pakistan
Dr Bahlool Khan
FCPS Resident Cardiology, Medical Officer, Lady reading Hospital MTI Peshawar, Pakistan