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A systematic review and meta-analysis of the factors associated with nonadherence and discontinuation of statins among people aged ≥65 Years


Ofori-Asenso, R and Jakhu, A and Curtis, AJ and Zomer, E and Gambhir, M and Jaana Korhonen, M and Nelson, M and Tonkin, A and Liew, D and Zoungas, S, A systematic review and meta-analysis of the factors associated with nonadherence and discontinuation of statins among people aged ≥65 Years, Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 73, (6) pp. 798-805. ISSN 1079-5006 (2018) [Refereed Article]

Copyright Statement

Copyright 2018 the authors.

DOI: doi:10.1093/gerona/glx256


Background: Older individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed.

Methods: We conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques.

Results: Forty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39-1.98), female gender (OR 1.08, 95% CI 1.03-1.13), current smoker (OR 1.12, 95% CI 1.03-1.21), higher copayments (OR 1.38, 95% CI 1.25-1.52), new user (OR 1.58, 95% CI 1.21-2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06-1.09), primary prevention (OR 1.49, 95% CI 1.40-1.59), having respiratory disorders (OR 1.17, 95% CI 1.12-1.23) or depression (OR 1.11, 95% CI 1.06-1.16), and not having renal disease (OR 1.09, 95% CI 1.04-1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06-1.36), current smoker (OR 1.14, 95% CI 1.06-1.23), higher copayment (OR 1.61, 95% CI 1.53-1.70), higher number of medications (OR 1.04, 95% CI 1.01-1.06), presence of dementia (OR 1.18, 95% CI 1.02-1.36), cancer (OR 1.22, 95% CI 1.11-1.33) or respiratory disorders (OR 1.19, 95% CI 1.05-1.34), primary prevention (OR 1.66, 95% CI 1.24-2.22), and not having hypertension (OR 1.13, 95% CI 1.07-1.20) or diabetes (OR 1.09, 95% CI 1.04-1.15).

Conclusion: Interventions that target potentially modifiable factors including financial and social barriers, patients' perceptions about disease risk as well as polypharmacy may improve statin use in the older population.

Item Details

Item Type:Refereed Article
Keywords:adherence, HMG-CoA reductase inhibitors, persistence, risk indicators
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:123852
Year Published:2018
Web of Science® Times Cited:40
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-01-30
Last Modified:2022-08-25

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