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Adherence and persistence among statin users aged 65 years and over: A systematic review and meta-analysis


Ofori-Asenso, R and Jakhu, A and Zomer, E and Curtis, AJ and Korhonen, MJ and Nelson, M and Gambhir, M and Tonkin, A and Liew, D and Zoungas, S, Adherence and persistence among statin users aged 65 years and over: A systematic review and meta-analysis, Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 73, (6) pp. 813-819. ISSN 1079-5006 (2018) [Refereed Article]

Copyright Statement

Copyright 2017 The Authors

DOI: doi:10.1093/gerona/glx169


Background: Older people (aged ≥ 65 years) have distinctive challenges with medication adherence. However, adherence and persistence patterns among older statin users have not been comprehensively reviewed.

Methods: As part of a broader systematic review, we searched Medline, Embase, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effects, CENTRAL and the National Health Service Economic Evaluation Database through December 2016 for English articles reporting adherence and/or persistence among older statin users. Data were analysed via descriptive methods and meta-analysis using random-effect modeling.

Results: Data from > 3 million older statin users in 82 studies conducted in over 40 countries were analysed. At 1-year follow up, 59.7% (primary prevention 47.9%; secondary prevention 62.3%) of users were adherent (medication possession ratio [MPR] or proportion of days covered [PDC] ≥ 80%). For both primary and secondary prevention subjects, 1-year adherence was worse among individuals aged > 75 than those aged 65-75 years. At 3 and ≥ 10 years, 55.3% and 28.4% of users were adherent, respectively. The proportion of users persistent at 1-year was 76.7% (primary prevention 76.0%; secondary prevention 82.6%). Additionally, 68.1% and 61.2% of users were persistent at 2 and 4 years, respectively. Among new statin users, 48.2% were non-adherent and 23.9% discontinued within the first year. The proportion of statin users who were adherent based on self-report was 85.5%.

Conclusions: There is poor short and long term adherence and persistence among older statin users. Strategies to improve adherence and reduce discontinuation are needed if the intended cardiovascular benefits of statin treatment are to be realised.

Item Details

Item Type:Refereed Article
Keywords:HMG-CoA reductase inhibitors, discontinuation, cardiovascular disease prevention
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Nelson, M (Professor Mark Nelson)
ID Code:121730
Year Published:2018 (online first 2017)
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2017-10-12
Last Modified:2018-06-22

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