Proportion and Risk Indicators of Nonadherence to Statin Therapy: A Meta-analysis

Lemstra, Mark; Blackburn, David; Crawley, A. E.; Fung, Ryan

doi:10.1016/j.cjca.2012.05.007

Cited by 172 publications

(159 citation statements)

References 83 publications

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“…The rates of nonadherence in our study are similar to those previously reported from Finland 35 and elsewhere, 1,4 including studies involving nonworking and older populations. As expected, 3−5 patients with a history of cardiovascular disease or diabetes had better adherence to statin therapy than those without these comorbidities.…”

Section: Discussionsupporting

confidence: 80%

Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities

Halava

Korhonen

Huupponen

et al. 2014

CMAJ

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Section: Discussionsupporting

confidence: 80%

Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities

Halava

Korhonen

Huupponen

et al. 2014

CMAJ

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“…However, we show that lower or no copayment was still associated with higher adherence to therapy in CVD, as illustrated by previous analyses. 55 56 These findings echo the conclusions of prior analyses of health system financing in other disease areas, 57 suggesting as with FDC therapy, that in the field of adherence to CVD drug therapy, there is scope for research, practice and policy to cross disease boundaries, especially in low-income countries. Universal healthcare coverage has been emphasised in the sustainable development goals, 58 offering opportunities and challenges to embed full prescription coverage for secondary prevention for CVD in cross-sectoral approaches, which research and global health player must embrace.…”

Section: Discussionsupporting

confidence: 73%

Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: A systematic review

Werba

Khandelwal

Nambiar

et al. 2017

Nutrition, Metabolism and Cardiovascular Diseases

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Background: Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy.Objectives: To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level.Methods: Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin-renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers.

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“…6 However, many patients who are prescribed statins, especially those in primary prevention, do not adhere to the treatment. 7 Low SEP is one of the predictors of nonadherence to preventive therapies, including statins, although previous research has reported varying results on the strength of this association. 7,8 Several studies, 7,[9][10][11][12] yet not all, 13 have found low income to predict statin nonadherence.…”

mentioning

confidence: 99%

“…7 Low SEP is one of the predictors of nonadherence to preventive therapies, including statins, although previous research has reported varying results on the strength of this association. 7,8 Several studies, 7,[9][10][11][12] yet not all, 13 have found low income to predict statin nonadherence. Results on the association between education and statin nonadherence are mixed: low education level has been associated with statin nonadherence, 9,10 but higher education has also been found to predict statin nonadherence 9,11,13 or there has been no association.…”

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confidence: 99%

“…7,9 Although this simplification is appealing, it leads to loss of information on medication-taking patterns over time. Group-based trajectory modeling (GBTM) 15 offers an alternative method for summarizing longitudinal data on medication Background-Previous research shows that low socioeconomic position (SEP; especially low income) is associated with statin nonadherence.…”

mentioning

confidence: 99%

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Socioeconomic Inequalities in Statin Adherence Under Universal Coverage

Aarnio

Martikainen

Winn

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Research on the association between SEP and statin adherence has mainly defined adherence through measures that reduce longitudinal medication-taking behavior into a single number, 12,13 such as the proportion of days covered (PDC). 7,9 Although this simplification is appealing, it leads to loss of information on medication-taking patterns over time. Group-based trajectory modeling (GBTM) 15 offers an alternative method for summarizing longitudinal data on medication Background-Previous research shows that low socioeconomic position (SEP; especially low income) is associated with statin nonadherence. We investigated the relationship between SEP and statin adherence in a country with universal coverage using group-based trajectory modeling in addition to the proportion of days covered. Methods and Results-Using data from Finnish healthcare registers, we identified 116 846 individuals, aged 45 to 75 years, who initiated statin therapy for primary prevention of cardiovascular disease. We measured adherence as proportion of days covered over an 18-month period since initiation and identified different adherence patterns based on monthly adherence with group-based trajectory modeling. When adjusted for age, marital status, residential area, clinical characteristics, and copayment, low SEP was associated with statin nonadherence (proportion of days covered <80%) among men (eg, lowest versus highest income quintile: odds ratio, 1.41; 95% confidence interval, 1.32-1.50; basic versus higher-degree education: odds ratio, 1.18; 95% confidence interval, 1.13-1.24; unemployment versus employment: odds ratio, 1.17; 95% confidence interval, 1.10-1.25). Among women, the corresponding associations were different (P<0.001 for sex-byincome quintile, sex-by-education level, and sex-by-labor market status interactions) and mainly nonsignificant. Results based on adherence trajectories showed that men in low SEP were likely to belong to trajectories presenting a fast decline in adherence. Conclusions-Low SEP was associated with overall and rapidly increasing statin nonadherence among men. Conversely, in women, associations between SEP and nonadherence were weak and inconsistent. adherence. GBTM accounts for the dynamic nature of adherence and identifies long-term patterns of the repeatedly measured adherence and groups of individuals with similar patterns. 16,17 Statin adherence trajectories have also been shown to predict cardiovascular events. 18Despite the universal healthcare, socioeconomic disparities in CVD have been documented also in Finland: lower SEP has been associated with higher CVD morbidity and mortality, lower use of statins, and lower revascularization rates. 3,[19][20][21] The aim of our study was to determine the association of SEP with nonadherence and adherence trajectories in Finnish patients initiating statin therapy for primary prevention of CVD. To refine the estimation of the effect of SEP on statin nonadherence, we measured adherence as 18-month adherence trajectories in addition to a conventional dichot...

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Proportion and Risk Indicators of Nonadherence to Statin Therapy: A Meta-analysis

Cited by 172 publications

References 83 publications

Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities

Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities

Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: A systematic review

Socioeconomic Inequalities in Statin Adherence Under Universal Coverage

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