Document Detail


Association between short-term effectiveness of statins and long-term adherence to lipid-lowering therapy.
MedLine Citation:
PMID:  15998926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The relationship between low-density lipoprotein (LDL) cholesterol reduction in the first 3 months of statin therapy and medication adherence during a 33-month follow-up period was studied. METHODS: A retrospective cohort study was conducted among enrollees in a Southeastern managed care plan who started therapy with atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin between October 1999 and August 2001, were enrolled for > or =12 months before and > or =6 months after treatment initiation, and had at least one LDL cholesterol measurement in the year before and 4-12 weeks after the start of therapy. Patients were followed up via electronic pharmacy and medical records for up to 33 more months. The follow-up period was divided into 3-month intervals; patients were considered adherent if statin therapy was available > or =80% of the time. A generalized linear model for repeated measures quantified the association between change in LDL cholesterol at 4-12 weeks and medication adherence in subsequent intervals, adjusting for demographic, clinical, and health-service-use variables. RESULTS: The final sample consisted of 9510 patients. Medication adherence decreased significantly over time: 59%, 40%, 34%, and 21% of patients were adherent at 3, 6, 12, and 36 months, respectively. Mean +/- S.D. LDL cholesterol reduction at 12 weeks was 28.9% +/- 19.9%. The relative LDL cholesterol reduction at 12 weeks was significantly and independently associated with subsequent medication adherence: Compared with subjects in the first quartile of LDL cholesterol reduction, those in quartiles 2, 3, and 4 were more likely to be adherent in any subsequent interval (adjusted odds ratio [95% confidence interval], 1.26 [1.12-1.42], 1.25 [1.11-1.40], and 1.15 [1.02-1.29], respectively). Other independent predictors of adherence in months 4-36 included adherence during the initial three months of therapy, age, and recent history of coronary revascularization. CONCLUSION: Greater reduction in LDL cholesterol levels during the first three months of statin therapy was associated with greater adherence to lipid-lowering drug therapy.
Authors:
Joshua S Benner; Michael F Pollack; Timothy W Smith; Michael F Bullano; Vincent J Willey; Setareh A Williams
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  62     ISSN:  1079-2082     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-06     Completed Date:  2005-11-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1468-75     Citation Subset:  IM    
Affiliation:
ValueMedics Research, LLC, Falls Church, VA 22406, USA. josh.benner@valuemedics.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cholesterol, LDL / blood*
Cohort Studies
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*,  therapeutic use
Hypercholesterolemia / drug therapy*
Male
Middle Aged
Patient Compliance*
Retrospective Studies
Chemical
Reg. No./Substance:
0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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