Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Emil Hagström, Uppsala University, Sweden
- Second opponent: Professor Eva Ringdal Pedersen, University of Bergen, Norway
- Third member and chair of the evaluation committee: Professor Jørgen Gravning, University of Oslo
Chair of the Defence
Professor Kjetil Retterstøl, University of Oslo
Principal Supervisor
Consultant, Senior Researcher Elise Sverre, Drammen Hospital, Vestre Viken
Summary
Lipid-lowering therapy with statins remains the cornerstone in the prevention and treatment of patients with atherosclerotic cardiovascular disease. However, some of these patients face challenges in adhering to statin treatment, which increases their risk of new cardiovascular events. The effect of reduced adherence on cholesterol levels and clinical outcomes remains unclear, and new tools are required to identify these patients.
The aims of the thesis were to assess the changes and variations in low-density lipoprotein cholesterol levels during short-time statin discontinuation, to validate a novel blood test for statin adherence by measuring statin metabolites in a prospective pharmacology study, and to compare this method with other measures of adherence using pharmacy registry data in a cross-sectional study.
Low-density lipoprotein cholesterol levels significantly increased by almost 30% within just four days without statin. These levels exhibited high individual variability both in baseline levels at study start and in daily increase.
Measurements of statin in blood accurately discriminates adherence and reduce adherence with high sensitivity and specificity. This test is straightforward and ready to use in clinical practice.
This novel blood test demonstrated high agreement on adherence when compared with measurements using pharmacy registry data, both when evaluated in the three months prior to blood sampling and during long-term follow-up of median 5.9 years.
Short-term statin discontinuation, as may occur with reduced adherence, may pose previously unrecognized risks for patients. Direct measurement of statin metabolites in blood could serve as a supplementary tool to ensure optimal statin treatment. This method is easy to implement in clinical practice and shows high agreement with both short-term and long-term adherence measurements derived from pharmacy registry data.
Additional information
Contact the research support staff.