Abstract

Dyslipidemia is a major risk factor for cardiovascular disease, the leading cause of death worldwide. Statins have been shown to significantly reduce morbidity and mortality in patients with coronary artery disease and in patients with hyperlipidemia. However, there is a significant gap between expected and actual benefits; this may be attributed to poor adherence to statin therapy. Literature search was conducted by using Pubmed, Wiley interscience, and EMBASE electronic databases for relevant studies for the meta-analysis. Inclusion criteria in this analysis were randomized controlled trials, retrospective analysis of data from randomized controlled trials, and observational studies. Adherence to statin therapy is suboptimal in both primary and secondary prevention of cardiovascular disease. The aim of this metanalysis was to assess non-adherence rates to statins in patients enrolled in both primary and secondary cardiovascular diseases prevention and to evaluate the impact of statins non-adherence over time on cardiac morbidity and mortality. Causes of non-adherence to statins are shown a discrepancy and include patient factors, practitioner factors and health system factors. Non-adherence is associated with adverse health outcomes and increased costs of health care. Non-adherence to statins is a significant issue for the prevention and treatment of cardiovascular disease. Increased awareness of the causes and solutions for overcoming non-adherence including safer prescribing, improvent in physician-patient alliance and reduction in drug costs, will enhance the cost-effectiveness of the use of statins and significantly improve patient care and outcomes.

Key words: Statins, non-adherence, cardiovascular diseases.

Abbreviation

ACE, Angiotensin converting Enzyme; AFCAPS/ texCAPS, Air Force/Texas Coronary Atherosclerosis Prevention Study; ASTEROID, A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden; ATP III, Adult Treatment Panel III; LYS, cost per life year saved; CABGE, Coronary Artery Graft Bypass surgery; CARE, Cholesterol and Recurrent Events; CHAMP, Cardiovascular Hospitalization Atherosclerosis Management Program; CHD, Coronary Heart Disease; CURVES, Comparative dose efficacy study of atorvastatin versus simvastatin; EXCEL, Expanded Clinical Evaluation of Lovastatin; GRACE, Gender, Race and Clinical Experience; HMG-COA, Hydroxy methyl glutaryl coenzyme A; HMO, Health Maintenance organizations; HPS, Heart Protection Study; IDEAL, Incremental Decrease in End Points through Aggressive Lipid Lower; JUPITER, Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin trial; LDL-C, Low density lipoprotein cholesterol; LIPID, Long-Term Intervention with Pravastatin in Ischaemic Disease; MACE, Major adverse cardiovascular events; NCEPG, National Cholesterol Education program guidelines;  SPARCL, Stroke Prevention by Aggressive Reduction in Cholesterol Levels; TIA, Transient Ischemic Attack; VLDL-C, Very low-density lipoprotein cholesterol; BMQ, Beliefs about Medicines Questionnaire; WOSCoPS, West of Scotland Coronary Prevention Study; 4S study, Scandinavian Simvastatin Survival Study; WAI, Working Alliance Inventory.