Skip to main content
SpringerLink
Log in

Effectiveness of Interventions to Increase Adherence to Statin Therapy

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

A number of large randomized controlled trials (RCTs) have documented the effectiveness of HMG-CoA reductase inhibitor (‘statin’) therapy for both primary and secondary prevention of coronary heart disease. Current international guidelines, therefore, recommend the use of statin therapy in patients with or at high risk for coronary heart disease. Unfortunately, patient adherence to statin therapy is unsatisfactory. In patients taking statins for secondary prevention, non-adherence ranges from 42% to 64%; for those taking these drugs for primary prevention, non-adherence is even higher (e.g. 75%). Interventions to increase patient adherence to statin therapy are therefore required. In this review, we summarize the existing evidence relating to interventions for increasing adherence to statin therapy. After searching MEDLINE, CINAHL, EMBASE, CENTRAL and the Health Technology Assessment databases using appropriate search terms, we found ten RCTs, one non-randomized controlled trial, and four ‘before-after’ trials. In four of the ten RCTs and in the non-randomized controlled trial, intervention was associated with a significant increase in the percentage of patients adhering to statin therapy compared with the control group. The remaining six RCTs found no significant difference in adherence between the intervention and control groups. All four before-after trials reported an increase in adherence to statin therapy after the intervention. However, this increase may also have been due to secular trends and changes in medical practice following the publication of the landmark statin trials. Given the inconsistency of the findings and the limitations of certain study designs, RCTs with a large sample size are needed to further investigate the effectiveness of adherence-increasing interventions in patients with statin therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9

    Google Scholar 

  2. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–9

    Article  PubMed  CAS  Google Scholar 

  3. The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349–57

    Article  Google Scholar 

  4. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7

    Article  PubMed  CAS  Google Scholar 

  5. Downs JR, Clearfield M, Wels S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels. JAMA 1998; 279: 1615–22

    Article  PubMed  CAS  Google Scholar 

  6. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360: 7–22

    Article  Google Scholar 

  7. Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation 2002; 106: 388–91

    Article  PubMed  Google Scholar 

  8. Smith SC, Blair SN, Bonow RO, et al. AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. J Am Coll Cardiol 2001; 38: 1581–3

    Article  PubMed  Google Scholar 

  9. De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2003; 24: 1601–10

    Article  PubMed  Google Scholar 

  10. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288: 462–7

    Article  PubMed  Google Scholar 

  11. Wright DJ, Grayson AD, Jackson M, et al. The reality of treating dyslipidaemia in patients with coronary heart disease: a primary care survey. Int J Clin Pract 2003; 57: 488–91

    PubMed  CAS  Google Scholar 

  12. Schrott HG, Bittner V, Vittinghoff E, et al. Adherence to National Cholesterol Education Program Treatment goals in postmenopausal women with heart disease: the Heart and Estrogen/Progestin Replacement Study (HERS). The zHERS Research Group. JAMA 1997; 277: 1281–6

    Article  PubMed  CAS  Google Scholar 

  13. Sueta CA, Chowdhury M, Boccuzzi SJ, et al. Analysis of the degree of undertreatment of hyperlipidemia and congestive heart failure secondary to coronary artery disease. Am J Cardiol 1999; 83: 1303–7

    Article  PubMed  CAS  Google Scholar 

  14. Avorn J, Monette J, Lacour A, et al. Persistence of use of lipid-lowering medications. JAMA 1998; 279: 1458–62

    Article  PubMed  CAS  Google Scholar 

  15. Pineiro F, Gil V, Pastor R, et al. Factors involved in the non-compliance of the pharmacologic treatment of dyslipidemia. Aten Primaria 1998; 21: 425–30

    PubMed  CAS  Google Scholar 

  16. Benner JS, Glynn RJ, Mogun H, et al. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002; 288: 455–61

    Article  PubMed  Google Scholar 

  17. EUROASPIRE I and II Group. Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. Lancet 2001; 357: 995–1001

    Article  Google Scholar 

  18. Larsen J, Vaccheri A, Anderson M, et al. Lack of adherence to lipid-lowering drug treatment: a comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy. Br J Clin Pharmacol 2000; 49: 463–71

    Article  PubMed  CAS  Google Scholar 

  19. Banks T, Ali N. Coronary care physician 1994–2000 adherence to 1993 National Cholesterol Education Program diet and lipid recommendations. J Natl Med Assoc 2001; 93: 87–91

    PubMed  CAS  Google Scholar 

  20. Packham C, Pearson J, Robinson J, et al. Use of statins in general practice, 1996–8: cross-sectional study. BMJ 2000; 320: 1583–4

    Article  PubMed  CAS  Google Scholar 

  21. Larsen J, Anderson M, Kragstrup J, et al. Changes in the utilisation of lipidlowering drugs over a 6-year period (1993–1998) in a Danish population. Eur J Clin Pharmacol 2001; 57: 343–8

    Article  PubMed  CAS  Google Scholar 

  22. Maviglia SM, Teich JM, Fiskio J, et al. Using an electronic medical record to identify opportunities to improve compliance with cholesterol guidelines. J Gen Intern Med 2001; 16: 531–7

    Article  PubMed  CAS  Google Scholar 

  23. Levy AR, O’Brien BJ, McMullen E, et al. Rapid increase in statins newly dispensed to Ontario seniors between 1994 and 2000. Can J Cardiol 2003; 19: 665–9

    PubMed  Google Scholar 

  24. Morris S, McGuire A, Caro J, et al. Strategies for the management of hypercholesterolaemia: a systematic review of the cost-effectiveness literature. J Health Serv Res Policy 1997; 2: 231–50

    PubMed  CAS  Google Scholar 

  25. Durrington P. The human and economic costs of undertreatment with statins. Int J Clin Pract 2002; 56: 357–68

    PubMed  CAS  Google Scholar 

  26. Volmer T, Kielhorn A. Kosten der Non-Compliance. Gesundh Okon Qual Manag 1999; 4: 55–61

    Google Scholar 

  27. Strandberg TE, Pitkala K, Berglind S, et al. Possibilities of multifactorial cardiovascular disease prevention in patients aged 75 and older: a randomized controlled trial. Drugs and Evidence Based Medicine in the Elderly (DEBATE) Study. Eur Heart J 2003; 24: 1216–22

    Article  PubMed  Google Scholar 

  28. Ammerman AS, Keyserling TC, Atwood JR, et al. A randomized controlled trial of a public health nurse directed treatment program for rural patients with high blood cholesterol. Prev Med 2003; 96: 340–51

    Article  Google Scholar 

  29. Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management. Arch Intern Med 2002; 162: 1149–55

    Article  PubMed  Google Scholar 

  30. Vale MJ, Jelinek MV, Best JD, et al. Coaching patients with coronary heart disease to achieve the target cholesterol: a method to bridge the gap between evidencebased medicine and the “real world”-randomized controlled trial. J Clin Epidemiol 2002; 55: 245–52

    Article  PubMed  Google Scholar 

  31. Guthrie RM. The effects of postal and telephone reminders on compliance with pravastatin therapy in a national registry: results of the first myocardial infarction risk reduction program. Clin Ther 2001; 23: 970–80

    Article  PubMed  CAS  Google Scholar 

  32. Allison TG, Farkouh ME, Smars PA, et al. Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (a chest pain evaluation in the emergency room [CHEER substudy). Am J Cardiol 2000; 86: 133–8

    Article  PubMed  CAS  Google Scholar 

  33. Faulkner MA, Wadibia EC, Lucas BD, et al. Impact of pharmacy counseling on compliance and effectiveness of combination lipid-lowering therapy in patients undergoing coronary artery revascularization: a randomized, controlled trial. Pharmacotherapy 2000; 20: 410–6

    Article  PubMed  CAS  Google Scholar 

  34. Feder G, Griffiths C, Eldridge S, et al. Effect of postal prompts to patients and general practitioners on the quality of primary care after a coronary event (POST): randomized controlled trial. BMJ 1999; 318: 1522–6

    Article  PubMed  CAS  Google Scholar 

  35. Marquez Contreras E, Casado Martinez JJ, Lopez de Andres M, et al. Therapeutic compliance in dyslipidemias: a trial of the efficacy of health education. Aten Primaria 1998; 22: 79–84

    Google Scholar 

  36. DeBusk RF, Houston Miller N, Superko HR, et al. A case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med 1994; 120: 721–9

    PubMed  CAS  Google Scholar 

  37. Senaratne MPJ, Griffiths J, Mooney D, et al. Effectiveness of a planned strategy using cardiac rehabilitation nurses for the management of dyslipidemia in patients with coronary artery disease. Am Heart J 2001; 142: 975–81

    Article  PubMed  CAS  Google Scholar 

  38. Truppo C, Keller VA, Reusch MT, et al. The effect of a comprehensive, mail-based motivational program for patients receiving lipid-lowering therapy. Manag Care Interface 2003; 16: 35–40

    PubMed  Google Scholar 

  39. Gavish D, Leibovitz E, Elly I, et al. Follow-up in a lipid clinic improves the management of risk factors in cardiovascular disease patients. Isr Med Assoc J 2002; 4: 694–7

    PubMed  Google Scholar 

  40. Fonarow GC, Gawlinski A, Moughrabi S, et al. Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalisation Atherosclerosis Management Program (CHAMP). Am J Cardiol 2001; 87: 819–22

    Article  PubMed  CAS  Google Scholar 

  41. Robinson JG, Conroy C, Wickemeyer WJ. A novel telephone-based system for management of secondary prevention to a low-density lipoprotein cholesterol ≤100 mg/dl. Am J Cardiol 2000; 85: 305–8

    Article  PubMed  CAS  Google Scholar 

  42. Haynes RB, McDonald H, Garg AX, Montague P. Interventions for helping patients to follow prescriptions for medications (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Update Software, 2003

    Google Scholar 

  43. Newell SA, Bowman JA, Cockburn JD. A critical review of interventions to increase compliance with medication-taking, obtaining medication refills, and appointment-keeping in the treatment of cardiovascular disease. Prev Med 1999; 29: 535–48

    Article  PubMed  CAS  Google Scholar 

  44. Lacy CR, Suh DC, Barone JA, et al. Impact of a targeted intervention on lipidlowering therapy in patients with coronary artery disease in the hospital setting. Arch Intern Med 2002; 162: 468–73

    Article  PubMed  Google Scholar 

  45. Fretheim A, Oxman AD, Treweek S, et al. Rational prescribing in primary care (RaPP-trial): a randomized trial of a tailored intervention to improve prescribing of antihypertensive and cholesterol-lowering drugs in general practice. BMC Health Serv Res 2003; 3: 5–12

    Article  PubMed  Google Scholar 

  46. Mehta RH, Montoye CK, Gallogly M, et al. Improving quality of care for acute myocardial infarction: the Guidelines Applied in Practice (GAP) Initiative. JAMA 2002; 287: 1269–76

    Article  PubMed  Google Scholar 

  47. Muhlestein JB, Horne BD, Bair TL, et al. Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. Am J Cardiol 2001; 87: 257–61

    Article  PubMed  CAS  Google Scholar 

  48. Fonarow GC. In-hospital initiation of statin therapy in patients with acute coronary events. Curr Atheroscler Rep 2003; 5: 394–402

    Article  PubMed  Google Scholar 

  49. Paradiso-Hardy FL, Gordon WL, Jackevicius CA, et al. The importance of inhospital statin therapy for patients with acute coronary syndromes. Pharmacotherapy 2003; 23: 506–13

    Article  PubMed  CAS  Google Scholar 

  50. Siskind A, Johnson M, Qureshi A, et al. The impact of automatic prescriptions on reducing low-density lipoprotein cholesterol levels. Eff Clin Pract 2000; 3: 240–6

    PubMed  CAS  Google Scholar 

  51. Goff CV. An employer coalition to reduce costs and improve adherence. Manag Care 2001; 10(11 Suppl.): 14–6

    PubMed  CAS  Google Scholar 

  52. Willich SN, Müller-Nordhorn J, Englert H, et al. Disease-related costs in patients with hypercholesterolaemia [abstract]. Eur Heart J 2003; 24 Suppl.: 586

    Article  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Luisenstrasse 57, Berlin, D-10117, Germany

    Jacqueline Müller-Nordhorn & Stefan N. Willich

Authors
  1. Jacqueline Müller-Nordhorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan N. Willich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacqueline Müller-Nordhorn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Müller-Nordhorn, J., Willich, S.N. Effectiveness of Interventions to Increase Adherence to Statin Therapy. Dis-Manage-Health-Outcomes 13, 73–82 (2005). https://doi.org/10.2165/00115677-200513020-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200513020-00001

Keywords

Search

Navigation