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

doi:10.1016/j.cjca.2012.05.007

Canadian Journal of Cardiology

Volume 28, Issue 5, September–October 2012, Pages 574-580

https://doi.org/10.1016/j.cjca.2012.05.007 Get rights and content

Abstract

Background

Nonadherence to chronic disease medications is important. A growing body of literature suggests that better delivery of established therapies would save more lives than would discovery of innovations. Our first objective was to quantify the proportion of adherence to statin medications. The second objective was to provide estimates of risk indicators associated with nonadherence to statin medications.

Methods

We performed a systematic literature review and meta-analysis of all studies published between database inception and June of 2011 that reviewed adherence, and risk indicators associated with nonadherence, to statin medications.

Results

In the end, 67 studies met our inclusion and exclusion criteria and passed our methodological-quality evaluation. Among observational studies, 49.0% (95% confidence interval [CI], 48.9%-49.2%) of patients were adherent to statin medications at 1 year of follow-up. Among randomized trials, 90.3% (95% CI, 89.8%-90.8%) of patients were adherent to statin medications at 1 year of follow-up. The association between 147 variables and adherence to statin medications was determined. After meta-analysis, only 6 variables were associated with nonadherence to statin medications: primary prevention (rate ratio = 1.52; 95% CI, 1.50-1.53); new statin users (rate ratio = 1.46; 95% CI, 1.33-1.61); copayment (rate ratio = 1.28; 95% CI, 1.09-1.50; lower income status (rate ratio = 1.26; 95% CI, 1.16-1.37); fewer than 2 lipid tests performed (rate ratio = 1.38; 95% CI, 1.16-1.64), and not having hypertension (rate ratio = 1.16; 95% CI, 1.12-1.21).

Conclusions

This study provides some insight into the extent of nonadherence by study type along with 6 risk indicators associated with nonadherence to statin medications.

Résumé

Introduction

La non-observance du traitement médicamenteux de la maladie chronique est importante. Une littérature de plus en plus vaste suggère qu'une meilleure offre de traitements établis sauverait plus de vie que le ferait la découverte d'innovations. Notre premier objectif était de quantifier la proportion d'observance au traitement par une statine. Le second objectif était de fournir l'estimation d'indicateurs de risque associés à la non-observance au traitement par une statine.

Méthodes

Nous avons effectué une revue de la littérature et une méta-analyse de toutes les études publiées entre la création de la base de données et juin 2011 sur l'observance au traitement par une statine et les indicateurs de risque associés à la non-observance de ce traitement.

Résultats

À la fin, 67 études ont répondu aux critères d'inclusion et d'exclusion et réussi notre évaluation de qualité méthodologique. Parmi les études d'observation, 49,0 % (intervalle de confiance [IC] de 95 %, 48,9 %-49,2 %) des patients suivaient rigoureusement leur traitement par une statine après 1 an de suivi. Parmi les essais aléatoires, 90,3 % (IC de 95 %, 89,8 %-90,8 %) des patients suivaient rigoureusement leur traitement par une statine après 1 an de suivi. Le lien entre les 147 variables et l'observance au traitement par une statine a été déterminé. Après la méta-analyse, seulement 6 variables ont été associées à la non-observance au traitement par une statine: la prévention primaire (ratio des taux = 1,52; IC de 95 %, 1,50-1,53); les nouveaux utilisateurs de statines (ratio des taux = 1,46; IC de 95 %, 1,33-1,61); la quote-part (ratio des taux = 1,28; IC de 95 %, 1,09-1,50; un plus faible revenu (ratio des taux = 1,26; IC de 95 %, 1,16-1,37); moins de 2 bilans lipidiques effectués (ratio des taux = 1,38; IC de 95 %, 1,16-1,64) et le fait de ne pas souffrir d'hypertension (ratio des taux = 1,16; IC de 95 %, 1,12-1,21).

Conclusions

Cette étude donne un aperçu de l'étendue de la non-observance au traitement par le plan d'étude ainsi que 6 indicateurs de risque associés à la non-observance au traitement par une statine.

Section snippets

Methods

A systematic literature review was performed by accessing the databases PubMed, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, Database of Abstracts of Reviews of Effects (DARE), National Health Service Economic Evaluation Database (NHSEED), Health Technology Assessment Database (HTAD), and EMBASE, from database inception till June of 2011.

All relevant Medical Subject Headings and free-text terms describing cardiovascular disease were combined

Results

A review of PubMed, PsychINFO, CINAHL, Cochrane Central, DARE, NHSEED, HTAD, and EMBASE identified 1574 articles. From this, 991 articles were removed for lack of relevance. Another 69 articles were removed because of duplication. After full abstract review, 295 articles were removed after the inclusion and exclusion criteria were applied. The remaining 219 articles were subjected to methodological quality review, and as a result, 152 articles were rejected. In the end, 67 articles (53 cohorts

Discussion

Among observational studies, 49.0% of patients were adherent to statin medications at 1 year of follow-up, in comparison with 90.3% of patients in randomized trials. After meta-analysis, only 6 variables were associated with nonadherence to statin medications: primary prevention, new statin users, copayment, lower income status, fewer than 2 lipid tests performed, and not having hypertension.

There are a number of explanations for the wide difference found between RCTs and observational studies.

Disclosures

M. L. is funded by an unconditional research grant from the Ministry of Health in the Province of Saskatchewan which obtained an unconditional research grant from Merck Frosst/Schering Pharmaceuticals. D. B. has educational financial support from the Province of Saskatchewan's Ministry of Health, AstraZeneca Canada, Merck Frosst Schering, and Pfizer Canada. A. C. and R. F. have no conflicts of interest to disclose.

None of the sponsors were involved in developing this study or writing the

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Systematic review/meta-analysisProportion and Risk Indicators of Nonadherence to Statin Therapy: A Meta-analysis

Abstract

Background

Methods

Results

Conclusions

Résumé

Introduction

Méthodes

Résultats

Conclusions

Section snippets

Methods

Results

Discussion

Disclosures

J Clin Epidemio1

Clin Ther

Clin Ther

Am Heart J

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J

Mayo Clin Proc

Am Heart J

Arch Cardiovasc Dis

Clin Ther

Clin Ther

Clin Ther

Am J Med

Atherosclerosis

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Clin Ther

Am Heart J

Lancet

Am J Cardiol

Prev Med

Am J Gastroenterol

Can J Cardiol

Interventions for enhancing medication adherence

Cochrane Database Syst Rev

Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction

JAMA

We need minimally disruptive medicine

BMJ

Quality improvement: science and action

Circulation

Adherence to medication

N Engl J Med

Interventions to improve adherence to lipid lowering medication

Cochrane Database Syst Rev

Predictors of nonadherence to statins: a systematic review and meta-analysis

Ann Pharmacother

Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography

Int J Epidemiol

The statistical basis of meta-analysis

Stat Methods Med Res

A meta-analysis of school based marijuana and alcohol prevention programs in targeting adolescents aged 10-15 years old

Addict & Res Theory

A systematic review of drug and alcohol use by socioeconomic status in adolescents aged 10-15 years

Can J Public Health

A systematic review of depressed mood and anxiety by socioeconomic status in adolescents aged 10-15 years

Can J Public Health

Statin compliance in the Umbrian population

Eur J Clin Pharmacol

Persistence with lipid-lowering therapy: influence of the type of lipid-lowering agent and drug benefit plan option in elderly patients

J Manage Care Pharm

Persistence of use of lipid-lowering medications: a cross-national study

JAMA

Long-term persistence in use of statin therapy in elderly patients

JAMA

Systematic review/meta-analysis
Proportion and Risk Indicators of Nonadherence to Statin Therapy: A Meta-analysis