Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis

Ofori‐Asenso, Richard; Jakhu, Avtar; Zomer, Ella; Curtis, Andrea J.; Korhonen, Maarit Jaana; Nelson, Mark; Gambhir, Manoj; Tonkin, Andrew; Liew, Danny; Zoungas, Sophia

doi:10.1093/gerona/glx169

Cited by 71 publications

(99 citation statements)

References 29 publications

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“…This observation is consistent with data from other longitudinal studies . In a recent meta‐analysis that pooled data from more than 3 million older statin users from over 40 countries, it was noted that the proportion adherent (PDC/medication possession ratio ≥ 0.80) declined from 60% at 6 months to just 28% at 10 years . These patterns highlight the need for support with adherence at commencement of treatment and for a longer period as part of regular medication management plans .…”

Section: Discussionsupporting

confidence: 83%

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Journal of Diabetes

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Section: Discussionsupporting

confidence: 83%

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Journal of Diabetes

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“…Their results may therefore inform decisions on treatment initiation but are probably less applicable to the real‐life setting where the continuation of statins in considered. The overall adherence to statins of cohort participants was low (28% among those <75 y and 25% among those >75 y) but consistent with previous observational studies …”

Section: Discussionsupporting

confidence: 89%

“…We studied prevalent statin users, reflecting an increasingly common clinical scenario; this approach is necessary and valid when it is not feasible to follow up from treatment initiation . Most statin users fail to adhere to their treatment, and usage patterns vary considerably over time (ie, patients may alternate between periods of statin use and cessation) . To account for changing treatment patterns, we modeled statin use as the cumulative, annually updated, proportion of standard doses claimed (DDDs).…”

Section: Discussionmentioning

confidence: 99%

“…Adherence to statin treatment is consistently associated with lower levels of LDL‐C and with fewer hospitalizations and ASCVD events . However, less than 50% of those older than age 65 adhere to statin therapy during the first year, and adherence decreases with older age and in the following years . Importantly, adherence to preventive therapy may also be a marker for engaging in other healthy behaviors, such as better diet or less smoking (“healthy adherer effect”) …”

mentioning

confidence: 99%

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Statin Use Over 65 Years of Age and All‐Cause Mortality: A 10‐Year Follow‐Up of 19 518 People

Eilat‐Tsanani

Mor

Schonmann

2019

J American Geriatrics Society

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OBJECTIVES As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long‐term effects of adherence to statins on mortality and cardiovascular morbidity among older adults. DESIGN A historical population‐based cohort study using routinely collected data. SETTING Clalit Health Services Northern District. PARTICIPANTS We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years. MEASUREMENTS We fitted Cox regression models to assess the association between the adherence to statin therapy and all‐cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time‐updated variables. RESULTS The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All‐cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] = .66; 95% confidence interval [CI] = .56‐.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR = .80; 95% CI = .71‐.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men. CONCLUSION Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038–2044, 2019

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“…There are some international studies that address estimating the frequency of SAM using administrative data, but they consider either only severe SAM based on hospital data (hospitalization due to SAM) or SAM restricted to rhabdomyolysis and/or include laboratory values, and thus from a methodological standpoint are not comparable with the study conducted here, which observes SAM exclusively by means of diagnoses (including in the outpatient sector). Therefore, it may be assumed that in these hospital‐based studies, only the most severe SAM is recorded, and the estimates of incidence rates are accordingly lower.…”

Section: Discussionmentioning

confidence: 91%

Statin‐associated myopathy. Assessment of frequency based on data of all statutory health insurance funds in Germany

Ihle

Dippel

Schubert

2018

Pharmacology Res & Perspec

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Aim of the study was to assess the incidence of statin‐associated myopathy (SAM) under real‐life conditions in Germany. Database: Administrative data (master data, diagnoses, prescriptions) for all individuals in Germany insured with the Statutory Health Insurance. Basic population: individuals 18 years and older who have been insured continually from 2009 to 2011 (52.9 million; 29.9 million men, 23.9 million women). Data access is provided by the German Institute of Medical Documentation and Information, DIMDI) according to the Data Transparency Regulation of 2012. Statins: identification with the ATC–Codes: C10AA, C10BA and C10BX. Study population: incident statin users in 2010 with a diagnosis of lipid disorders (ICD‐10‐GM E78, excluding patients with: E78.1, E78.3, E78.6 in eight quarters before index prescription. Definition of SAM: documentation of myopathy (ICD‐10‐GM G72.0, G72.8; G72.9, M60.8, M60.9, M79.1) in the first statin prescription quarter or in one of the three following quarters. The first event is considered for the incidence estimate. The daily doses included in a package were classified as “days under therapy” (by assuming one DDD) and taken as exposition time. SAM was found in 1.9% of 531 672 incident statin users. The percentage differs according to the patterns of statin use: the lowest incidence is observed in those with only one prescription (1.3%), the highest incidence with 5.0% is observed in those who not only stopped the treatment within 365 days, but who also had their statin changed. Administrative data including diagnoses from ambulatory care provide a realistic estimate of SAM frequency in every day practice.

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Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis

Abstract: There is poor short and long term adherence and persistence among older statin users. Strategies to improve adherence and reduce discontinuation are needed if the intended cardiovascular benefits of statin treatment are to be realized.

Cited by 71 publications

References 29 publications

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Statin Use Over 65 Years of Age and All‐Cause Mortality: A 10‐Year Follow‐Up of 19 518 People

Statin‐associated myopathy. Assessment of frequency based on data of all statutory health insurance funds in Germany

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