Abstract
Background
Many patients at high cardiovascular risk do not reach targets for low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP). Depression is a frequent comorbidity in these patients and contributes to poor medication adherence.
Objective
The aim of this study was to elucidate the associations between adherence to lipid-and BP-lowering drugs, the diagnosis of depression, and the control of LDL-C and BP.
Patients and methods
This study was conducted as multicenter, single-visit cross-sectional study in Germany. Adherence was assessed by the Morisky Medication Adherence Scale-8 (MMAS-8), and depression was assessed as documented in the patient chart.
Results
A total of 3,188 ambulatory patients with hypercholesterolemia (39.8%), stable coronary artery disease (CAD; 7.4%), or both (52.9%) were included. Patients had a history of myocardial infarction (30.8%), diabetes (42.0%), were smokers (19.7%), and 16.1% had the investigator-reported diagnosis of depression. High or moderate adherence to lipid-lowering medication compared to low adherence was associated with lower LDL-C levels (105.5±38.3 vs 120.8±42.4 mg/dL) and lower BP (systolic BP 133.4±14.5 vs 137.9±13.9 mmHg, diastolic BP 78.3±9.6 vs 81.8±9.6 mmHg) and with a higher proportion of patients achieving the guideline-recommended LDL-C (16.9% vs 10.1%) and BP target (52.2% vs 40.8%, all comparisons P<0.0001). Adherence was worse in patients with depression. Correspondingly, patients with depression showed higher LDL-C levels, higher BP, and a lower probability of achieving the LDL-C and BP goal. Medication adherence correlated between BP- and lipid-lowering medications.
Conclusion
Self-reported medication adherence can be easily obtained in daily practice. A low adherence and the diagnosis of depression identify patients at risk for uncontrolled LDL-C and BP who likely benefit from intensified care.
Acknowledgments
The study was funded by Servier Deutschland GmbH, Germany. Statistical analyses were supported by Pharmalog, Institut für klinische Forschung GmbH, Oskar-Messter-Straße 29, Ismaning, Germany.
Disclosure
Julius L Katzmann reports grants from Servier Deutschland GmbH, Germany, non-financial support from Pharmalog, Institut für klinische Forschung GmbH, Oskar-Messter-Straße 29, Ismaning, Germany, during the conduct of the study; Michael Böhm reports personal fees from Amgen, personal fees from Bayer, personal fees from Servier, personal fees from Medtronic, personal fees from Boehringer Ingelheim, nothing from Vifor, personal fees from Bristol Myers Squibb, outside the submitted work; and Ulrich Laufs report other from Servier, during the conduct of the study. The authors report no other conflicts of interest in this work.
Author contributions
JLK and UL designed the study and wrote the article. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.