Effectiveness of Interventions to Increase Adherence to Statin Therapy

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A number of large randomized controlled trials (RCTs) have documented the effectiveness of HMG-CoA reductase inhibitor (‘statin’) therapy for both primary and secondary prevention of coronary heart disease. Current international guidelines, therefore, recommend the use of statin therapy in patients with or at high risk for coronary heart disease. Unfortunately, patient adherence to statin therapy is unsatisfactory. In patients taking statins for secondary prevention, non-adherence ranges from 42% to 64%; for those taking these drugs for primary prevention, non-adherence is even higher (e.g. 75%). Interventions to increase patient adherence to statin therapy are therefore required. In this review, we summarize the existing evidence relating to interventions for increasing adherence to statin therapy. After searching MEDLINE, CINAHL, EMBASE, CENTRAL and the Health Technology Assessment databases using appropriate search terms, we found ten RCTs, one non-randomized controlled trial, and four ‘before-after’ trials. In four of the ten RCTs and in the non-randomized controlled trial, intervention was associated with a significant increase in the percentage of patients adhering to statin therapy compared with the control group. The remaining six RCTs found no significant difference in adherence between the intervention and control groups. All four before-after trials reported an increase in adherence to statin therapy after the intervention. However, this increase may also have been due to secular trends and changes in medical practice following the publication of the landmark statin trials. Given the inconsistency of the findings and the limitations of certain study designs, RCTs with a large sample size are needed to further investigate the effectiveness of adherence-increasing interventions in patients with statin therapy.

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