This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (208)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Aging/ Geriatrics  • Cardiovascular Disease/ Myocardial Infarction  • Treatment Adherence  • Adherence  • Alert me on articles by topic

Cynthia A. Jackevicius, BScPhm,MSc,FCSHP; Muhammad Mamdani, PharmD,MA,MPH; Jack V. Tu, MD,PhD,FRCPC

JAMA. 2002;288:462-467.

Context  Landmark clinical trials have demonstrated the survival benefits of statins, with benefits usually starting after 1 to 2 years of treatment. Research prior to these trials of older lipid-lowering agents demonstrated low levels of 1-year adherence.

Objective  To compare 2-year adherence following statin initiation in 3 cohorts of patients: those with recent acute coronary syndrome (ACS), those with chronic coronary artery disease (CAD), and those without coronary disease (primary prevention).

Design and Setting  Cohort study using linked population-based administrative data from Ontario.

Patients  All patients aged 66 years or older who received at least 1 statin prescription between January 1994 and December 1998 and who did not have a statin prescription in the prior year were followed up for 2 years from their first statin prescription. There were 22 379 patients in the ACS, 36 106 in the chronic CAD, and 85 020 in the primary prevention cohorts.

Main Outcome Measures  Adherence to statins, defined as a statin being dispensed at least every 120 days after the index prescription for 2 years.

Results  Two-year adherence rates in the cohorts were only 40.1% for ACS, 36.1% for chronic CAD, and 25.4% for primary prevention. Relative to the ACS cohort, nonadherence was more likely among patients receiving statins in the chronic CAD (relative risk [RR], 1.14; 95% CI, 1.11-1.16) and primary prevention cohorts (RR, 1.92; 95% CI, 1.87-1.96).

Conclusions  Elderly patients with and without recent ACS have low rates of adherence to statins. This suggests that many patients initiating statin therapy may receive no or limited benefit from statins because of premature discontinuation.

Author Affiliations: Department of Health Policy, Management, and Evaluation (Ms Jackevicius and Drs Mamdani and Tu), Department of Medicine (Dr Tu), Pharmacy Department and Women's Health Program, University Health Network-Toronto General Hospital; Institute for Clinical Evaluative Sciences (Ms Jackevicius and Drs Mamdani and Tu), University of Toronto; and Division of General Internal Medicine, Sunnybrook and Women's College Health Sciences Centre (Dr Tu), Toronto, Ontario.

RELATED ARTICLES

Long-term Persistence in Use of Statin Therapy in Elderly Patients
Joshua S. Benner, Robert J. Glynn, Helen Mogun, Peter J. Neumann, Milton C. Weinstein, and Jerry Avorn
JAMA. 2002;288(4):455-461.
ABSTRACT | FULL TEXT  

Elderly Patients' Adherence to Statin Therapy
William B. Applegate
JAMA. 2002;288(4):495-497.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Discontinuation of statin therapy following an acute myocardial infarction: a population-based study
Daskalopoulou et al.
Eur Heart J 2008;29:2083-2091.
ABSTRACT | FULL TEXT  

Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group
Schocken et al.
Circulation 2008;117:2544-2565.
ABSTRACT | FULL TEXT  

Use of Ezetimibe in the United States and Canada
Jackevicius et al.
NEJM 2008;358:1819-1828.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post-Myocardial Infarction Medicare Beneficiaries
Choudhry et al.
Circulation 2008;117:1261-1268.
ABSTRACT | FULL TEXT  

Association of Early Follow-up After Acute Myocardial Infarction With Higher Rates of Medication Use
Daugherty et al.
Arch Intern Med 2008;168:485-491.
ABSTRACT | FULL TEXT  

Do patients' expectations influence their use of medications?: Qualitative study
Dolovich et al.
cfp 2008;54:384-393.
ABSTRACT | FULL TEXT  

Achieving Vascular Risk Factor Targets: A Survey of a London General Practice
Levine et al.
ANGIOLOGY 2008;59:36-46.
ABSTRACT  

Preventing and managing diabetic complications in elderly patients
HORNICK and ARON
Cleveland Clinic Journal of Medicine 2008;75:153-158.
ABSTRACT | FULL TEXT  

Medication Adherence Following Coronary Artery Bypass Graft Surgery: Assessment of Beliefs and Attitudes
Khanderia et al.
The Annals of Pharmacotherapy 2008;42:192-199.
ABSTRACT | FULL TEXT  

Family practice patients' adherence to statin medications
Natarajan et al.
cfp 2007;53:2144-2145.
ABSTRACT | FULL TEXT  

Use of statins and beta-blockers after acute myocardial infarction according to income and education
Rasmussen et al.
J. Epidemiol. Community Health 2007;61:1091-1097.
ABSTRACT | FULL TEXT  

Asymmetric Paternalism to Improve Health Behaviors
Loewenstein et al.
JAMA 2007;298:2415-2417.
FULL TEXT  

Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy: The CHECK-UP Study: A Randomized Controlled Trial
Grover et al.
Arch Intern Med 2007;167:2296-2303.
ABSTRACT | FULL TEXT  

Discontinuation of Statin Therapy and Clinical Outcome After Ischemic Stroke
Colivicchi et al.
Stroke 2007;38:2652-2657.
ABSTRACT | FULL TEXT  

How can adherence to lipid-lowering medication be improved? A systematic review of randomized controlled trials
Schedlbauer et al.
Fam Pract 2007;24:380-387.
ABSTRACT | FULL TEXT  

Helping Patients With Type 2 Diabetes Mellitus Make Treatment Decisions: Statin Choice Randomized Trial
Weymiller et al.
Arch Intern Med 2007;167:1076-1082.
ABSTRACT | FULL TEXT  

Effect of Monitoring Bone Turnover Markers on Persistence with Risedronate Treatment of Postmenopausal Osteoporosis
Delmas et al.
J. Clin. Endocrinol. Metab. 2007;92:1296-1304.
ABSTRACT | FULL TEXT  

Diabetes Is Not Treated as a Coronary Artery Disease Risk Equivalent
Shah et al.
Diabetes Care 2007;30:381-383.
FULL TEXT  

Relationship Between Adherence to Evidence-Based Pharmacotherapy and Long-term Mortality After Acute Myocardial Infarction
Rasmussen et al.
JAMA 2007;297:177-186.
ABSTRACT | FULL TEXT  

Adherence to evidence-based statin guidelines reduces the risk of hospitalizations for acute myocardial infarction by 40%: a cohort study
Penning-van Beest et al.
Eur Heart J 2007;28:154-159.
ABSTRACT | FULL TEXT  

The Prevention Of Cardiovascular Disease: Have We Really Made Progress?
Pearson
Health Aff (Millwood) 2007;26:49-60.
ABSTRACT | FULL TEXT  

Potentially Unintended Discontinuation of Long-term Medication Use After Elective Surgical Procedures
Bell et al.
Arch Intern Med 2006;166:2525-2531.
ABSTRACT | FULL TEXT  

Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol: A Randomized Controlled Trial
Lee et al.
JAMA 2006;296:2563-2571.
ABSTRACT | FULL TEXT  

Commentary: Predicting future coronary heart disease deaths in Finland and elsewhere
Capewell
Int J Epidemiol 2006;35:1253-1254.
FULL TEXT  

Achieving Target Cholesterol Goals After Stroke: Is In-Hospital Statin Initiation the Key?
Sanossian et al.
Arch Neurol 2006;63:1081-1083.
ABSTRACT | FULL TEXT  

Adherence and Persistence with Single-Dosage Form Extended-Release Niacin/Lovastatin Compared with Statins Alone or in Combination with Extended-Release Niacin
LaFleur et al.
The Annals of Pharmacotherapy 2006;40:1274-1279.
ABSTRACT | FULL TEXT  

Effectiveness and efficiency of different guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study
Manuel et al.
BMJ 2006;332:1419.
ABSTRACT | FULL TEXT  

Duration of Adjuvant Chemotherapy for Colon Cancer and Survival Among the Elderly
Neugut et al.
JCO 2006;24:2368-2375.
ABSTRACT | FULL TEXT  

Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: a meta-analysis of randomized controlled trials.
Briel et al.
JAMA 2006;295:2046-2056.
ABSTRACT | FULL TEXT  

Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction
Gislason et al.
Eur Heart J 2006;27:1153-1158.
ABSTRACT | FULL TEXT  

Treat to Target: ABCs for the Elderly
DOC News 2006;3:4-4.
FULL TEXT  

Management of Dyslipidemia in Special Populations
Tovar and Schering
Journal of Pharmacy Practice 2006;19:63-78.
ABSTRACT  

Revisiting Rose: strategies for reducing coronary heart disease.
Manuel et al.
BMJ 2006;332:659-662.
FULL TEXT  

Proliferation of Cardiac Technology in Canada: A Challenge to the Sustainability of Medicare
Alter et al.
Circulation 2006;113:380-387.
ABSTRACT | FULL TEXT  

Medication-Attributed Adverse Effects in Placebo Groups: Implications for Assessment of Adverse Effects
Rief et al.
Arch Intern Med 2006;166:155-160.
ABSTRACT | FULL TEXT  

Challenges and Opportunities for Pharmacoepidemiology in Drug-Therapy Decision Making
Etminan et al.
J Clin Pharmacol 2006;46:6-9.
ABSTRACT | FULL TEXT  

The AdHOC Study of Older Adults' Adherence to Medication in 11 Countries
Cooper et al.
AJGP 2005;13:1067-1076.
ABSTRACT | FULL TEXT  

Managing Abnormal Blood Lipids: A Collaborative Approach
Fletcher et al.
Circulation 2005;112:3184-3209.
ABSTRACT | FULL TEXT  

Adherence to Medications by Patients After Acute Coronary Syndromes
Sud et al.
The Annals of Pharmacotherapy 2005;39:1792-1797.
ABSTRACT | FULL TEXT  

Adherence to Medication
Osterberg and Blaschke
NEJM 2005;353:487-497.
FULL TEXT  

Hyperlipidemia in Seniors: Too Much, Too Little, Too Late?
Hirth
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:595-597.
FULL TEXT  

The Challenge of Achieving National Cholesterol Goals in Patients With Diabetes
Kennedy et al.
Diabetes Care 2005;28:1029-1034.
ABSTRACT | FULL TEXT  

The 2003 Canadian recommendations for dyslipidemia management: Revisions are needed
Manuel et al.
CMAJ 2005;172:1027-1031.
FULL TEXT  

Adherence to Statin Therapy and LDL Cholesterol Goal Attainment by Patients With Diabetes and Dyslipidemia
Parris et al.
Diabetes Care 2005;28:595-599.
ABSTRACT | FULL TEXT  

Statin Use and Survival Outcomes in Elderly Patients With Heart Failure
Ray et al.
Arch Intern Med 2005;165:62-67.
ABSTRACT | FULL TEXT  

Corticosteroid Use after Hospital Discharge among High-risk Adults with Asthma
Krishnan et al.
Am. J. Respir. Crit. Care Med. 2004;170:1281-1285.
ABSTRACT | FULL TEXT  

Impact of Concurrent Medication Use on Statin Adherence and Refill Persistence
Grant et al.
Arch Intern Med 2004;164:2343-2348.
ABSTRACT | FULL TEXT  

Long term persistence with statin treatment in daily medical practice
Mantel-Teeuwisse et al.
Heart 2004;90:1065-1066.
FULL TEXT  

Effectiveness of Statin Therapy in Adults With Coronary Heart Disease
Wilt et al.
Arch Intern Med 2004;164:1427-1436.
ABSTRACT | FULL TEXT  

Benefits of Individualized Counseling by the Pharmacist on the Treatment Outcomes of Hyperlipidemia in Hong Kong
Lee et al.
J Clin Pharmacol 2004;44:632-639.
ABSTRACT | FULL TEXT  

Lipid-Lowering Therapy With Statins in High-Risk Elderly Patients: The Treatment-Risk Paradox
Ko et al.
JAMA 2004;291:1864-1870.
ABSTRACT | FULL TEXT  

Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction
Dalal et al.
BMJ 2004;328:693-697.
FULL TEXT  

Impact of Combination Evidence-Based Medical Therapy on Mortality in Patients With Acute Coronary Syndromes
Mukherjee et al.
Circulation 2004;109:745-749.
ABSTRACT | FULL TEXT  

Measurement, Correlates, and Health Outcomes of Medication Adherence Among Seniors
Vik et al.
The Annals of Pharmacotherapy 2004;38:303-312.
ABSTRACT | FULL TEXT  

The use of cholesterol-lowering medications after coronary revascularization
Brophy et al.
CMAJ 2003;169:1153-1157.
ABSTRACT | FULL TEXT  

Is concordance the primrose path to health?
Ferner
BMJ 2003;327:821-822.
FULL TEXT  

Polypharmacy and Medication Adherence in Patients With Type 2 Diabetes
Grant et al.
Diabetes Care 2003;26:1408-1412.
ABSTRACT | FULL TEXT  

The ALLHAT Lipid Lowering Trial--Less Is Less
Pasternak
JAMA 2002;288:3042-3044.
FULL TEXT  

JournalScan
Malik
Heart 2002;88:551-552.
FULL TEXT  

Elderly Patients' Adherence to Statin Therapy
Applegate
JAMA 2002;288:495-497.
FULL TEXT