Nonadherence to statins: individualized intervention strategies outside the pill box

Figures & data

Table 1 Classification of SAMS

Category	Definition
Myalgia	Muscle pain or weakness only
Myopathy	Muscle symptoms with a raised CK <10×ULN
Rhabdomyolysis	Muscle symptoms with a raised CK >10×ULN
Autoimmune myopathy	Muscle symptoms with muscle cell necrosis and presence of HMG-CoA reductase autoantibodies. CK levels persist ≥10 times the ULN 8 weeks after discontinuation of the statin.

Notes: Data compiled from Collins et al, Sathasivam and Lecky, Mammen, and Sweidan et al.^28–31

Abbreviations: CK, creatinine kinase; HMG-CoA, 3-hydroxy-3-methyl-glutaryl-coenzyme A; SAMS, statin-associated muscle symptoms; ULN, upper limit of normal.

Figure 1 Factors associated with statin nonadherence.

Table 2 Measures to quantify medication adherence

Direct methods	Indirect methods
• Direct observation by health care provider	• Patient education/adherence scale
• Measuring blood levels to yield quantitative data	• Pill counts
– Costly and time consuming	• Statistics on repeated prescriptions
	• Electronic monitoring systems in blister packs
	– Does not assure if the patient actually ingests the medication or
	whether patient takes the correct dose
	• Patient diaries
	• Combined electronic opening, pill counts, and interviews
	+ Minimize patient manipulation by revealing openings without pill intake

Note: Data compiled from Laufs et al, Maningat et al, and Gagnon et al.^13,14,92

Figure 2 Interventions for improving medication adherence.

Notes: Overall, the interventions can be differentiated as “before” and “after” prescription interventions. The strategies are multimodal varying from “patient education/counseling” to “adopting team-based” approaches. Effective approaches must involve strong partnerships between patients and health providers.

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