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Adherence to statin therapy in patients with high and very high cardiovascular risk in real clinical practice

https://doi.org/10.47093/2218-7332.2020.11.1.38-48

Abstract

Despite the proven efficacy of lipid-lowering therapy, adherence to long-term statin therapy in patients with cardiovascular disease remains low.

Aim. To study adherence to long-term statin therapy and factors associated with adherence in patients with high and very high cardiovascular risk (CVR) in real clinical practice.

Materials and methods. The single-center cohort study included 53 patients (mean age 68.1 ± 10.2 years) with high or very high CVR on the SCORE scale and have been taking statins for at least 3 months prior to inclusion in the study. The level of low-density lipoprotein cholesterol (LDL-C), cognitive impairment (MoCA test), anxiety and depression (HADS scale), presence of senile asthenia (FRAIL scale), M. Charlson comorbidity index were assessed. Adherence to statin therapy was assessed using the original questionnaire. The correlation between patient adherence and ordinal variables for the scores of the studied scales was studied.

Results. Completely adherent to statin therapy were only 12 (22%) patients, 14 (26%) were insufficiently adherent, 27 (51%) were non-adherent. The target level of LDL-С was achieved in 13 (25%) patients. 38 (72%) patients showed a decrease in cognitive functions; a positive correlation was found between adherence and the MoCA test (r = 0.44, p = 0.04). Clinical and subclinical depression and anxiety were noted in 12 (23%) and 14 (26%) patients, respectively. A statistically significant negative correlation was found between adherence and depression (r = –0.32; p = 0.04) and a positive correlation between adherence and anxiety (r = 0.44; p = 0.04). There was no statistically significant correlation between adherence and the FRAIL fragility scale, as well as the M. Charlson comorbidity index.

Conclusions. Depression and cognitive decline are associated with decreased adherence to statin therapy.

About the Authors

V. I. Podzolkov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Valery I. Podzolkov — MD, PhD, DMSc, Professor, Head of of Faculty Therapy Department № 2, Director of the Faculty Therapy Clinic

8/2, Trubetskaya str., Moscow, 119991



A. E. Bragina
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Anna E. Bragina — MD, PhD, DMSc, Professor, Faculty Therapy Department № 2

8/2, Trubetskaya str., Moscow, 119991



L. V. Vasil’eva
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Lubov’ V. Vasil’eva — MD, PhD, Assistant Professor, Faculty Therapy Department № 2

8/2, Trubetskaya str., Moscow, 119991



Yu. P. Grintsevich
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Yulia P. Grintsevich — student

8/2, Trubetskaya str., Moscow, 119991



Yu. N. Rodionova
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Yulia N. Rodionova — MD, PhD, Assistant Professor, Faculty Therapy Department № 2

8/2, Trubetskaya str., Moscow, 119991
Tel.: + 7 (906) 774-09-04



References

1. The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998; 339: 1349–57. https://doi.org/10.1056/NEJM199811053391902 PMID: 9841303

2. Sergienko I.V., Ansheles A.A., Drapkina O.M., et al. Issledovanie ANIChKOV: vliianie kombinirovannoi gipotenzivnoi i gipolipidemicheskoi terapii na serdechno-sosudistye oslozhneniia u patsientov vysokogo i ochen’ vysokogo riska. [ANICHKOV study: the effect of combined antihypertensive and hypolipidemic therapy on cardiovascular complications in high and very high risk patients]. Therapeutic archive. 2019; 91(4): 90–8 (In Russian). https://doi.org/10.26442/00403660.2019.04.000104

3. Sever P.S., Dahlof B., Poulter N.R., et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial — Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet. 2003; 361: 1149–58. https://doi.org/10.1016/S0140-6736(03)12948-0 PMID: 12686036

4. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C., Blackwell L., Emberson J,. et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010; 376: 1670–81. https://doi.org/10.1016/S0140-6736(10)61350-5

5. Mann D.M., Woodward M., Munther P., et al. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother. 2010; 44(9): 1410–21. https://doi.org/10.1345/aph.1P150 PMID: 20702755

6. Puchin’ian N.F., Dovgalevskii Ya.P., Dolotovskaia P.V., Furman N.V. Priverzhennost’ rekomendovannoi terapii bol’nykh, perenesshikh ostryi koronarnyi sindrom, i risk razvitiia serdechno-sosudistykh oslozhnenii v techenie goda posle gospitalizatsii. [The adherence to recommended therapy in patients after acute coronary syndrome, and risk of cardiovascular comp;ications within a year after hospital admission] Rational Pharmacotherapy in Cardiology. 2011; 7(5): 567–73 (In Russian). https://doi.org/10.20996/1819-6446-2011-7-5-567-573

7. Jackevicius C.A., Mamdani M., Tu J.V. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA. 2002; 288: 462–7. https://doi.org/10.1001/jama.288.4.462 PMID: 12132976

8. Lemstra M., Blackburn D., Crawley A., Fung R. Proportion and risk indicators of nonadherence to statin therapy: a meta-analysis. Can J Cardiol. 2012; 28(5): 574–80. https://doi.org/10.1016/j.cjca.2012.05.007 PMID: 22884278

9. Conroy R.M., Pyorala K., Fitzgerald A.P., et al. Estimation of tenyear risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24: 987–1003. https://doi.org/10.1016/s0195-668x(03)00114-3 PMID: 12788299

10. Mach F., Baigent C., Catapano A., et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardio vascular risk. European Heart Journal. 2020; 41(1): 111–88. https://doi.org/10.1093/eurheartj/ehz455

11. Charlson M., Pompei P., Ales K., Mackenzie C. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5): 373–83. https://doi.org/10.1016/0021-9681(87)90171-8 PMID: 3558716

12. Morley J., Malmstrom T., Miller D. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012; 16(7): 601–8. https://doi.org/10.1007/s12603-012-0084-2 PMID: 22836700

13. Tsoi K.K., Chan J.Y., Hirai H.W., et al. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015; 175(9): 1450–8. https://doi.org/10.1001/jamainternmed.2015.2152 PMID: 26052687

14. Andriushenko A.V., Drobizhev M.Yu., Dobrovol’skii A.V. Sravnitel’naia otsenka shkal CES-D, BDI i HADS(d) v diagnostike depressii v obshchemeditsinskoi praktike. [Comparative assessment scale CES-D, BDI and HADS (d) in the diagnosis of depression in general practice]. S.S. Korsakov Journal of Neurology and Psychiatry. 2003; 5: 11–8 (In Russian).

15. Catapano A.L., Graham I., De Backer G., et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). European heart journal. 2016; 253: 281–344. https://doi.org/10.1016/j.atherosclerosis.2016.08.018

16. Morisky D.E, Green L.W, Levine D.M. Concurrent and predictive validity of self-reported measure of medical adherence. Med Care. 1986; 24: 67–73. https://doi.org/10.1097/00005650-198601000-00007

17. Conn V.S., Hafdahl A.R., Cooper P.S., et al. Interventions to Improve Medication Adherence Among Older Adults: Meta-Analysis of Adherence Outcomes Among Randomized Controlled Trials. Gerontologist. 2009; 49(4): 447–62. https://doi.org/10.1093/geront/gnp037 PMID: 19460887

18. Oganov R.G., Kukharchuk V.V., Arutiunov G.P., et al. Sokhraniaiushchiesia narusheniia pokazatelei lipidnogo spektra u patsientov s dislipidemiei, poluchaiushchikh statiny, v real’noi klinicheskoi praktike v Rossiiskoi Federatsii (rossiiskaia chast’ issledovaniia DYSIS). [Persistent dyslipidemia in statin-treated patients: Russian real-world clinical practice data (Russian part of the DYSIS Study)]. Cardiovascular Therapy and Prevention. 2012; 11(4): 70–8 (In Russian). https://doi.org/10.15829/1728-8800-2012-4-70-78

19. Reiner Ž., De Backer G., Fras Z., et al. On behalf of the EUROASPIRE Investigators Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries e Findings from the EUROASPIRE IV survey. Atherosclerosis. 2016; 246: 243–50. https://doi.org/10.1016/j.atherosclerosis.2016.01.018 PMID: 26812002

20. Shal’nova S.A., Deev A.D., Metel’skaia V.A., et al. Informirovannost’ i osobennosti terapii statinami u lits s razlichnym serdechno-sosudistym riskom: issledovanie ESSE-RF. [Awareness and treatment specifics of statin therapy in persons with various cardiovascular risk: the study ESSE-RF]. Cardiovascular Therapy and Prevention. 2016; 15(4): 29–37 (In Russian). https://doi.org/10.15829/1728-8800-2016-4-29-37

21. Akhmedzhanov N. M., Nebieridze D. V., Safarian A. S., et al. Analiz rasprostranennosti giperkholesterinemii v usloviiakh ambulatornoi praktiki (po dannym issledovaniia ARGO): chast’ I. [Analysis of hypercholesterolemia prevalence in the outpatient practice (according to the ARGO STUDY): part I]. Rational Pharmacotherapy in Cardiology. 2015; 11(3): 253–60 (In Russian). https://doi.org/10.20996/1819-6446-2015-11-3-253-260

22. Ofori-Asenso R., Jakhu A., Curtis A.J., et al. A systematic review and meta-analysis of the factors sssociated with nonadherence and discontinuation of statins among people aged ≥65 Years. J Gerontol A Biol Sci Med Sci. 2018 May 9; 73(6): 798–805. https://doi.org/10.1093/gerona/glx256 PMID: 29360935

23. Yu G., Zhang Y., Wang Y., et al. Factors that contribute to poor adherence to statin therapy in coronary heart disease patients from Chongqing and measures to improve their therapeutic outcomes. Genes Dis. 2018; 5(4): 335–41. https://doi.org/10.1016/j.gendis.2018.01.001 PMID: 30591935

24. Mann D.M., Allegrante J.P., Natarajan S., et al. Predictors of Adherence to Statins for Primary Prevention. Cardiovasc Drugs Ther. 2007; 21: 311–6. https://doi.org/10.1007/s10557-007-6040-4 PMID: 17665294

25. Barnett K., Mercer S.W., Norbury M., et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836): 37–43. https://doi.org/10.1016/S0140-6736(12)60240-2

26. Lavikainen P., Helin-Salmivaara A., Eerola M., et al. Statin adherence and risk of acute cardiovascular events among women: a cohort study accounting for time-dependent confounding affected by previous adherence. BMJ Open. 2016; 6(6): e011306. https://doi.org/10.1136/bmjopen-2016-011306 PMID: 27259530

27. Hope H.F., Binkley G.M., Fenton S., et al. Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease. PLoS ONE. 2019; 14(1): e0201196. https://doi.org/10.1371/journal.pone.0201196 PMID: 30653535

28. Mohammed S., Arabi A., El-Menyar A., et al. Impact of polypharmacy on adherence to evidence-based medication in patients who underwent percutaneous coronary Intervention. Curr Vasc pharmacol. 2016; 14(4): 388–93. https://doi.org/10.2174/1570161113666151030105805 PMID: 26517700

29. Collard R.M., Boter H., Schoevers R.A., Oude Voshaar R.C. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60(8): 1487–92. https://doi.org/10.1111/j.1532-5415.2012.04054.x PMID: 22881367

30. Kirkpatrick A.C., Vincent A.S., Guthery L., Prodan C.I. Cognitive impairment is associated with medication nonadherence in asymptomatic carotid stenosis. Am J Med. 2014; 127(12): 1243–46. https://doi.org/10.1016/j.amjmed.2014.08.010 PMID: 25168078

31. Zhuravskaia N.Iu., Kutishenko N.P., Martsevich S.Iu., et al. Izuchenie priverzhennosti vrachebnym rekomendatsiiam u patsientov, perenesshikh mozgovoi insul’t. Rol’ trevogi i depressii. (Rezul’taty registra LIS-2). [Study of the physician recommendation adherence in patients after stroke. The role of anxiety and depression (registry LIS-2)]. Cardiovascular Therapy and Prevention. 2015; 14(2): 46–51 (In Russian). https://doi.org/10.15829/1728-8800-2015-2-46-51


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