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Erschienen in: Cardiovascular Drugs and Therapy 4/2007

01.08.2007

Predictors of Adherence to Statins for Primary Prevention

verfasst von: Devin M. Mann, John P. Allegrante, Sundar Natarajan, Ethan A. Halm, Mary Charlson

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 4/2007

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Abstract

Purpose

Statins are potent drugs for reducing cholesterol and cardiovascular disease; however, their effectiveness is significantly compromised by poor adherence. This prospective study was designed to identify potentially modifiable patient factors including medication, disease, and diet beliefs related to statin adherence.

Methods

Veterans (n = 71) given their first prescription of a statin for primary prevention were interviewed at baseline, 3 months, and 6 months regarding medication, disease, and diet beliefs along with self-reported statin adherence.

Results

At 6-month follow-up, 55% of the cohort was non-adherent with 10% reporting never having started their statin, 50% reporting misconceptions about the duration of treatment and a median use of <2 months among those who discontinued their statin. Multivariate predictors of non-adherence were expected short treatment duration (OR = 3.6, 1.4–9.4), low perceived risk of myocardial infarction (OR = 3.1, 1.1–8.7), concern about potential harm from statins (OR = 2.5, 1.0–6.3), being Hispanic (OR = 3.9, 1.0–15.2), and younger age (OR = 4.2, 1.1–15.8).

Conclusions

Poor adherence to statins was common in this primary prevention population with frequent early discontinuation despite access to low-cost medicines. Patient factors regarding the perception of risk, toxic effects of medication, expected treatment duration, as well as socio-demographic factors, were significant predictors of poor adherence and warrant further exploration.
Literatur
1.
Zurück zum Zitat Writing Group M, Rosamond W, Flegal K, et al. Heart disease and stroke statistics—2007 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006;106:1799–818. Writing Group M, Rosamond W, Flegal K, et al. Heart disease and stroke statistics—2007 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006;106:1799–818.
2.
Zurück zum Zitat Third Report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143. Third Report of the National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143.
3.
Zurück zum Zitat Grundy SM, Cleeman JI, Merz CNB, Brewer HB, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Circulation 2004;110:227–39.PubMedCrossRef Grundy SM, Cleeman JI, Merz CNB, Brewer HB, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Circulation 2004;110:227–39.PubMedCrossRef
4.
5.
Zurück zum Zitat Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: Systematic review and meta-analysis. BMJ 2003;326:1423–30.PubMedCrossRef Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: Systematic review and meta-analysis. BMJ 2003;326:1423–30.PubMedCrossRef
6.
Zurück zum Zitat Caspard H, Chan AK, Walker AM. Determinants of the differences in LDL-cholesterol after initiation of statin treatment. Ann Pharmacother 2006;40:21–6.PubMed Caspard H, Chan AK, Walker AM. Determinants of the differences in LDL-cholesterol after initiation of statin treatment. Ann Pharmacother 2006;40:21–6.PubMed
7.
8.
Zurück zum Zitat Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002;288:462–7.PubMedCrossRef Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002;288:462–7.PubMedCrossRef
9.
Zurück zum Zitat Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–13.PubMedCrossRef Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–13.PubMedCrossRef
10.
Zurück zum Zitat Morisky D, Ward H, Liu K. Self-reported medication taking behavior: a valid indicator for assessing compliance (abstract 26352). In: 129th meeting of the American Pharmacy Association. Atlanta; 2001. Morisky D, Ward H, Liu K. Self-reported medication taking behavior: a valid indicator for assessing compliance (abstract 26352). In: 129th meeting of the American Pharmacy Association. Atlanta; 2001.
11.
Zurück zum Zitat Shalansky SJ, Levy AR, Ignaszewski AP. Self-reported Morisky score for identifying nonadherence with cardiovascular medications. Ann Pharmacother 2004;38:1363–8.PubMedCrossRef Shalansky SJ, Levy AR, Ignaszewski AP. Self-reported Morisky score for identifying nonadherence with cardiovascular medications. Ann Pharmacother 2004;38:1363–8.PubMedCrossRef
12.
Zurück zum Zitat Elder JP, Ayala GX, Harris S. Theories and intervention approaches to health-behavior change in primary care. Am J Prev Med 1999;17:275–84.PubMedCrossRef Elder JP, Ayala GX, Harris S. Theories and intervention approaches to health-behavior change in primary care. Am J Prev Med 1999;17:275–84.PubMedCrossRef
13.
Zurück zum Zitat Leventhal H, Diefenbach M, Leventhal E. Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cogn Ther Res 1992;16. Leventhal H, Diefenbach M, Leventhal E. Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cogn Ther Res 1992;16.
14.
Zurück zum Zitat Brewer N, Chapman G, Brownlee S, Leventhal E. Cholesterol control, medication adherence and illness cognition. Br J of Health Psychol 2002;7:433–47.CrossRef Brewer N, Chapman G, Brownlee S, Leventhal E. Cholesterol control, medication adherence and illness cognition. Br J of Health Psychol 2002;7:433–47.CrossRef
15.
Zurück zum Zitat Yilmaz MB, Biyikoglu SF, Guray Y, et al. Level of awareness of on-treatment patients about prescribed statins. Cardiovasc Drugs Ther 2004;18:399–404.PubMedCrossRef Yilmaz MB, Biyikoglu SF, Guray Y, et al. Level of awareness of on-treatment patients about prescribed statins. Cardiovasc Drugs Ther 2004;18:399–404.PubMedCrossRef
16.
Zurück zum Zitat Tarn DM, Heritage J, Paterniti DA, Hays RD, Kravitz RL, Wenger NS. Physician communication when prescribing new medications. Arch Intern Med 2006;166:1855–62.PubMedCrossRef Tarn DM, Heritage J, Paterniti DA, Hays RD, Kravitz RL, Wenger NS. Physician communication when prescribing new medications. Arch Intern Med 2006;166:1855–62.PubMedCrossRef
17.
Zurück zum Zitat Aikens JE, Nease DE, Jr, Nau DP, Klinkman MS, Schwenk TL. Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication. Annals Family Med 2005;3:23.CrossRef Aikens JE, Nease DE, Jr, Nau DP, Klinkman MS, Schwenk TL. Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication. Annals Family Med 2005;3:23.CrossRef
18.
19.
Zurück zum Zitat Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:455–61.PubMedCrossRef Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002;288:455–61.PubMedCrossRef
20.
Zurück zum Zitat Brookhart MA, Patrick AR, Schneeweiss S, et al. Physician follow-up and provider continuity are associated with long-term medication adherence: a study of the dynamics of statin use. Arch Intern Med 2007;167:847–52.PubMedCrossRef Brookhart MA, Patrick AR, Schneeweiss S, et al. Physician follow-up and provider continuity are associated with long-term medication adherence: a study of the dynamics of statin use. Arch Intern Med 2007;167:847–52.PubMedCrossRef
21.
Zurück zum Zitat Benner JS, Tierce JC, Ballantyne CM, et al. Follow-up lipid tests and physician visits are associated with improved adherence to statin therapy. Pharmacoecon 2004;22:13–33. Benner JS, Tierce JC, Ballantyne CM, et al. Follow-up lipid tests and physician visits are associated with improved adherence to statin therapy. Pharmacoecon 2004;22:13–33.
22.
Zurück zum Zitat Ellis JJ, Erickson SR, Stevenson JG, Bernstein SJ, Stiles RA, Fendrick AM. Suboptimal statin adherence and discontinuation in primary and secondary prevention populations. Should we target patients with the most to gain? J Gen Intern Med 2004;19:638–45.PubMedCrossRef Ellis JJ, Erickson SR, Stevenson JG, Bernstein SJ, Stiles RA, Fendrick AM. Suboptimal statin adherence and discontinuation in primary and secondary prevention populations. Should we target patients with the most to gain? J Gen Intern Med 2004;19:638–45.PubMedCrossRef
23.
Zurück zum Zitat Gibson TB, Mark TL, McGuigan KA, Axelsen K, Wang S. The effects of prescription drug copayments on statin adherence. Am J Manag Care 2006;12:509–17.PubMed Gibson TB, Mark TL, McGuigan KA, Axelsen K, Wang S. The effects of prescription drug copayments on statin adherence. Am J Manag Care 2006;12:509–17.PubMed
24.
Zurück zum Zitat Morisky D, Green L, Levine D. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24:67–74.PubMedCrossRef Morisky D, Green L, Levine D. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24:67–74.PubMedCrossRef
25.
Zurück zum Zitat Yilmaz MB, Pinar M, Naharci I, et al. Being well-informed about statin is associated with continuous adherence and reaching targets. Cardiovasc Drugs Ther 2005;19:437–40.PubMedCrossRef Yilmaz MB, Pinar M, Naharci I, et al. Being well-informed about statin is associated with continuous adherence and reaching targets. Cardiovasc Drugs Ther 2005;19:437–40.PubMedCrossRef
Metadaten
Titel
Predictors of Adherence to Statins for Primary Prevention
verfasst von
Devin M. Mann
John P. Allegrante
Sundar Natarajan
Ethan A. Halm
Mary Charlson
Publikationsdatum
01.08.2007
Verlag
Springer US
Erschienen in
Cardiovascular Drugs and Therapy / Ausgabe 4/2007
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-007-6040-4

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