Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct;78(4):684-98.
doi: 10.1111/bcp.12339.

Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review

Mary A De Vera, Vidula Bhole, Lindsay C Burns, Diane Lacaille

Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review

Mary A De Vera et al. Br J Clin Pharmacol. 2014 Oct.

Abstract

Aims: While suboptimal adherence to statin medication has been quantified in real-world patient settings, a better understanding of its impact is needed, particularly with respect to distinct problems of medication taking. Our aim was to synthesize current evidence on the impacts of statin adherence, discontinuation and persistence on cardiovascular disease and mortality outcomes.

Methods: We conducted a systematic review of peer-reviewed studies using a mapped search of Medline, Embase and International Pharmaceutical Abstracts databases. Observational studies that met the following criteria were included: defined patient population;statin adherence exposure; defined study outcome [i.e. cardiovascular disease (CVD), mortality]; and reporting of statin-specific results.

Results: Overall, 28 studies were included, with 19 studies evaluating outcomes associated with statin adherence, six with statin discontinuation and three with statin persistence. Among adherence studies, the proportion of days covered was the most widely used measure, with the majority of studies reporting increased risk of CVD (statistically significant risk estimates ranging from 1.22 to 5.26)and mortality (statistically significant risk estimates ranging from 1.25 to 2.54) among non-adherent individuals. There was greater methodological variability in discontinuation and persistence studies. However, findings of increased CVD (statistically significant risk estimates ranging from 1.22 to 1.67) and mortality (statistically significant risk estimates ranging from 1.79 to 5.00) among nonpersistent individuals were also consistently reported.

Conclusions: Observational studies consistently report an increased risk of adverse outcomes associated with poor statin adherence. These findings have important implications for patients and physicians and emphasize the importance of monitoring and encouraging adherence to statin therapy.

PubMed Disclaimer

Figures

Figure 2
Figure 2
Risk estimates for the association between statin non-adherence and mortality outcomes according to adherence, discontinuation and persistence studies
Figure 3
Figure 3
Risk estimates for the association between statin non-adherence and cardiovascular disease outcomes according to adherence, discontinuation and persistence studies. Abbreviations are as follows: AMI, acute myocardial infarction; CAD, coronary artery disease; CHF, chronic heart failure; CVA, cerebrovascular accident; CVD, cardiovascular disease; IHD, ischaemic heart disease; VTE, venous thromboembolism
Figure 1
Figure 1
Systematic review study flow diagram
See this image and copyright information in PMC

Comment in

  • Common statin side effects explain poor compliance.
    Dimmitt SB, Stampfer HG, Warren JB. Dimmitt SB, et al. Br J Clin Pharmacol. 2015 Jul;80(1):170-1. doi: 10.1111/bcp.12594. Epub 2015 Jun 1. Br J Clin Pharmacol. 2015. PMID: 25612768 Free PMC article. No abstract available.

References

    1. Gaw A, Packard C, Shepherd J. Statins The HMG CoA Reductase Inhibitors in Perspective. London: Martin Dunitz Ltd; 2000.
    1. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, McKillop JH, Packard CJ. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301–1307. - PubMed
    1. 4S-Investigators. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) Lancet. 1994;344:1383–1389. - PubMed
    1. Heart Protection Study Collaborative G. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7–22. - PubMed
    1. Andrade SE, Walker AM, Gottlieb LK, Hollenberg NK, Testa MA, Saperia GM, Platt R. Discontinuation of antihyperlipidemic drugs–do rates reported in clinical trials reflect rates in primary care settings? N Engl J Med. 1995;332:1125–1131. - PubMed

Publication types

MeSH terms

Substances