A Systematic Review and Meta-analysis of the Factors Associated With Nonadherence and Discontinuation of Statins Among People Aged ≥65 Years

Ofori‐Asenso, Richard; Jakhu, Avtar; Curtis, Andrea J.; Zomer, Ella; Gambhir, Manoj; Korhonen, Maarit Jaana; Nelson, Mark; Tonkin, Andrew; Liew, Danny; Zoungas, Sophia

doi:10.1093/gerona/glx256

Cited by 51 publications

(69 citation statements)

References 76 publications

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“…Finally, we did not investigate whether specific statins or intensity were associated with higher or lower rates of adherence or persistence, or sociodemographic or lifestyle factors. However, a recent meta‐analysis involving more than 1.8 million older statin users in 13 countries found no significant difference in adherence or persistence according to statin type or intensity …”

Section: Discussionmentioning

confidence: 99%

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Journal of Diabetes

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Section: Discussionmentioning

confidence: 99%

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Journal of Diabetes

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“…5,62 First of all, the issue of treatment adherence, which is critical for a successful outcome, might be a problem in older patients. 63,64 In general, in studies with standard statin dosages, no difference in adverse events and serum enzyme levels (liver and muscular) were detected. 47,48 With intensive drug regimens compared with standard doses, a dose-dependent increase in liver and muscle enzyme could be detected, even if with limited clinical consequences.…”

Section: Safety Issuesmentioning

confidence: 95%

“…First of all, the issue of treatment adherence, which is critical for a successful outcome, might be a problem in older patients …”

Section: Clinical Experimental Evidence With Cholesterol‐lowering Agementioning

confidence: 99%

Management of high cholesterol levels in older people

Bertolotti

Lancellotti

Mussi

2019

Geriatrics Gerontology Int

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The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol‐lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug‐related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid‐lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375–383.

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“…The absence of comorbidities such as hypertension (odds ratio [OR] 1.13, 95% CI 1.07–1.20) and diabetes (OR 1.09, 95% CI 1.04–1.15) was associated with an increased likelihood of statin discontinuation but no effects of prescriber type were observed. Interestingly, no significant associations were noted between nonadherence or discontinuation and the statin type (i.e., active ingredient) .…”

Section: Introductionmentioning

confidence: 97%

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Ofori‐Asenso

Ilomäki

Tacey

et al. 2018

Brit J Clinical Pharma

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Aims The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. Methods Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first‐year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co‐payment; n = 4841) and concessional beneficiaries (with a lower co‐payment; n = 17 499). Results During the one‐year follow‐up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75–84 years and ≥85 years were more likely to discontinue than people aged 65–74 years (odds ratio 1.11, 95% confidence interval 1.04–1.19 and 1.38, 1.23–1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. Conclusions Among older adults prescribed statins, first‐year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.

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A Systematic Review and Meta-analysis of the Factors Associated With Nonadherence and Discontinuation of Statins Among People Aged ≥65 Years

Abstract: Interventions that target potentially modifiable factors including financial and social barriers, patients' perceptions about disease risk as well as polypharmacy may improve statin use in the older population.

Cited by 51 publications

References 76 publications

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

Management of high cholesterol levels in older people

Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

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