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Abstract
Objective: To identify and assess studies published over a 10 year period up to February 2016 which measure adherence or persistence with statins, to summarize their methods, strengths and weaknesses and to summarize evidence linking statin adherence/persistence with risk of cardiovascular events.
Methods: Electronic databases and abstracts from four major cardiovascular disease conferences were searched from January 2005 to February 2016. The study selection process was performed by two reviewers working independently. Studies were included if they reported data regarding patient adherence or persistence with statins in adults with primary hypercholesterolemia, using any type of study design or length of follow-up. One reviewer extracted the study data and assessed study quality, which was checked by a second reviewer independently. Given the heterogeneity between the included studies a narrative critique and summary is presented.
Results: We report on 84 real world studies which aimed to assess adherence or persistence with statins. The majority of studies concluded that good adherence/persistence was associated with reduction in cardiovascular events and mortality. In two studies high intensity statin regimens were associated with poorer patient adherence when compared to low intensity statins. Adherence and persistence with statin therapy also has an impact on hospitalization costs and other cardiovascular disease (CVD) related costs.
Conclusions: Adherence and persistence are associated with a reduction in CVD events and mortality. There was limited evidence to suggest that high intensity statin regimens are associated with poorer treatment adherence when compared to lower intensity regimens. Hence, more robust studies are required to establish this association. As recommended by the 2013 ACC/AHA, 2016 ESC and several other clinical guidelines, clinicians and pharmacy managers should regularly monitor statin therapy adherence.
Transparency
Declaration of funding
This study was funded by Amgen Inc. (Thousand Oaks, California, USA).
Author contributions: S.D.: concept and design; data inclusion assessment; data extraction and quality assessment; data analysis and interpretation; manuscript draft and final approval. R.G.W.Q.: concept and design data review and interpretation; drafting and final approval of the manuscript. C.A.F.: concept and design; data inclusion assessment; data extraction and quality assessment; data analysis and interpretation; drafting and final approval of the manuscript. S.d.K.: concept and design, literature searching, drafting and final approval of the manuscript. J.K.: concept and design; data analysis and interpretation; drafting and final approval of the manuscript. S.R.G.: concept and design data review and interpretation; drafting and final approval of the manuscript. R.J.S.: concept and design; data analysis and interpretation; drafting and final approval of the manuscript.
Declaration of financial/other relationships
R.G.W.Q. and S.R.G. have disclosed that they are Amgen Inc. employees and stockholders. S.D., C.A.F., S.d.K. and J.K. have disclosed that they are employees of Kleijnen Systematic Reviews (KSR) Ltd., an independent research company which has been paid by Amgen Inc. to carry out this work. R.J.S. has disclosed that he is a paid consultant to Amgen, Pfizer and Merck but was not paid for writing or editing the manuscript.
CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.
Acknowledgments
The authors acknowledge the help of the following reviewers who assisted with data extraction and quality assessment: Adrian V. Hernandez, Gillian Worthy, Kim Reid, Maíra Parra and Wilco Jacobs.