Medication adherence among persons with coronary heart disease and associations with blood pressure and low-density-lipoprotein-cholesterol

Abstract

Purpose To describe medication adherence to lipid-lowering drugs (LLDs), antihypertensive drugs, and acetylsalicylic acid (ASA) among persons with coronary heart disease (CHD) and explore its association with low-density-lipoprotein (LDL)-cholesterol, and systolic and diastolic blood pressure. Methods Based on record linkage between the seventh wave of the Tromsø Study and the Norwegian Prescription Database, medication adherence was calculated as the proportion of days covered (PDC) for persistent prevalent users in the period of 365 days before the attendance date. Multivariable linear regression models were used to assess the association between systolic and diastolic blood pressure and medication nonadherence to antihypertensive drugs, age, sex, lifestyle, body mass index (BMI), current and previous diabetes, and between LDL-cholesterol and medication nonadherence to LLDs, age, sex, lifestyle, BMI, and current and previous diabetes. Results Mean PDC was 0.94 for LLDs and antihypertensive drugs and 0.97 for ASA. Among persons with PDC ≥ 0.80 for LLDs, 12.0% had an LDL-cholesterol < 1.8 mmol/L. Blood pressure < 140/90 mmHg (< 140/80 mmHg if diabetes patient) was reached by 55.1% of those with a PDC ≥ 0.80 for antihypertensive drugs. Adherence to LLDs was associated with lower LDL-cholesterol, while neither systolic nor diastolic blood pressure was associated with adherence to antihypertensive drugs. Conclusion Adherence to antihypertensive drugs, LLDs, and ASA among persons with CHD were high despite low achievement of treatment goals for blood pressure and LDL-cholesterol. There was a statistically significant association between adherence to LLDs and LDL-cholesterol, but not between adherence to antihypertensive drugs and blood pressure.

Illness Perception, Self-Efficacy, and Medication Adherence in Patients With Coronary Artery Disease: A Path Analysis of Conceptual Model

“…Data analysis was carried out using the path analysis method that made it possible to more accurately investigate the interactions between multiple factors and thus determine the direct, indirect, and total effects of demographic, clinical, and behavioral variables on medication adherence. Results showed that more than half of the participants (61.8%) adhered to their medication regimen, which is consistent with previous studies (He et al, 2022; Pedersen et al, 2022; Silva Tinoco et al, 2021). It was also shown that greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age also had a negative effect on it.…”

Gaps and discontinuation of statin treatment in Norway: potential for optimizing management of lipid lowering drugs

“…Several other studies have investigated patterns of statin use in the realworld setting. 28,[34][35][36][37] In line with our results, previous studies indicate that there is an underutilization of high-intensity statin therapy 35,36 and that patients at high risk for CV events have high rates of discontinuation and poor adherence. 31,36 While many studies of adherence to lipid lowering treatment have focused on individual patients and specific lipid lowering drugs, we explore all three drug groups with a public health approach.…”

“…Even though we in this study do not have information on LDL-cholesterol levels, other Norwegian studies find clear association between lipid lowering treatment, LDL-cholesterol levels and CVD risk. 6,28,29 In line with this, a large European study shows that a significant number of patients do not achieve the guideline-recommended treatment targets for LDL-cholesterol in daily clinical practice and that few are using combination with non-statin lipid lowering drugs. 30 Immediate, combination therapy with statins and ezetimibe, at least to high-risk patients, has therefore recently been recommended by a European Position document.…”