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. 2019 Jan 17;14(1):e0201196.
doi: 10.1371/journal.pone.0201196. eCollection 2019.

Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease

Holly F Hope  1 , George M Binkley  1 , Sally Fenton  2 , George D Kitas  2   3 , Suzanne M M Verstappen  1   4 , Deborah P M Symmons  1
Affiliations

Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease

Holly F Hope et al. PLoS One. .

Abstract

Introduction: Previous research has shown that statin adherence for the primary prevention of CVD is lower compared to secondary prevention populations. Therefore the aim of this systematic review was to review predictors of statin adherence for the primary prevention of CVD.

Methods: A systematic search of papers published between Jan 1984 and May 2017 was conducted in PubMed, PsycINFO, EMbase and CINAHL databases. A study was eligible for inclusion if; 1) it was a study of the general population or of patients with familial hypercholesterolemia, hypertension, diabetes or arthritis; 2) statins were prescribed; 3) adherence was defined and measured as the extent to which patients followed their statin regimen during the period of prescription, and 4) it was an original trial or observational study (excluding case reports). A study was subsequently excluded if 1) results were not presented separately for primary prevention; 2) it was a trial of an intervention (for example patient education). Papers were reviewed by two researchers and consensus agreed with a third. A quality assessment (QA) tool was used to formally assess each included article. To evaluate the effect of predictors, data were quantitatively and qualitatively synthesised.

Results: In total 19 studies met the inclusion criteria and nine were evaluated as high quality using the QA tool. The proportion of patients classed as "adherent" ranged from 17.8% to 79.2%. Potential predictors of statin adherence included traditional risk factors for CVD such as age, being male, diabetes and hypertension. Income associated with adherence more strongly in men than women, and highly educated men were more likely and highly educated women less likely to be adherent. Alcohol misuse and high BMI associated with non-adherence. There was no association between polypharmacy and statin adherence. The evidence base for the effect of other lifestyle factors and health beliefs on statin adherence was limited.

Conclusion: Current evidence suggests that patients with more traditional risk factors for CVD are more likely to be adherent to statins. The implications for future research are discussed.

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Conflict of interest statement

No funding disclosure to make in relation to this systematic review. After review of the journal policy the authors of this manuscript have the following competing interests: Prof. George Kitas and Prof. Deborah Symmons were principal investigators with the project TRACE-RA a RCT of atorvastatin vs placebo for the primary prevention of cardiovascular events in patients with rheumatoid arthritis jointly funded by Arthritis Research UK and the British Heart Foundation (Grant Ref: 16514). The trial drugs and support for the associated biobank was provided by Pfizer Inc. The systematic review was not commissioned by a commercial company, none of the authors received any commercial funding during the period that the review was carried out, and the review has not been seen by any commercial company prior to submission to PLOS ONE.

Figures

Fig 1
Fig 1. PRISMA flow diagram of article selection process.
Fig 2
Fig 2. Percentage of patients adherent to statins grouped by follow-up and adherence measure.
MEMS; Medcation event monitoring system, Pharmacy refill; medication possession ratio (MPR) or Proportion of days covered (PDC).
Fig 3
Fig 3. The relationship between age and statin adherence.
*Wallach-Kildemoes; HMO: Health maintenance organisation; General: General population register; FH: Familial hypercholesterolemia; HC: Hypercholesterolemia; QA: Quality assessment; Adj. ES: Adjusted effect size; RR: Relative risk; OR: Odds ratio; MD: Mean difference.
Fig 4
Fig 4. The relationship between being male and statin adherence.
*Wallach-Kildemoes; HMO: Health maintenance organisation; General: General population register; HC: Hypercholesterolemia; QA: Quality assessment; Adj. ES: Adjusted effect size; RR: Relative risk; OR: Odds ratio.
Fig 5
Fig 5. The relationship between diabetes and statin adherence.
HMO: Health maintenance organisation; General: General population register; HC: Hypercholesterolemia; QA: Quality assessment; Adj. ES: Adjusted effect size; RR: Relative risk; OR: Odds ratio; MD: Mean difference.
Fig 6
Fig 6. The relationship between Hypertension and statin adherence.
*Wallach-Kildemoes; HMO: Health maintenance organisation; General: General population register; QA: Quality assessment; Adj. ES: Adjusted effect size.
Fig 7
Fig 7. The sex dependent relationship between education and statin adherence.
*Wallach-Kildemoes; HMO: Health maintenance organisation; General: General population register; QA: Quality assessment; Adj. ES: Adjusted effect size; RR: Relative risk; OR: Odds ratio.
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