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Cited by 1,232Medication Adherence and ComplianceLipoproteins and Cardiovascular HealthPharmaceutical Practices and Patient Outcomes

Long-term persistence in use of statin therapy in elderly patients

Benner, Joshua S.·2002·JAMA
DOI 10.1001/jama.288.4.455
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Abstract

CONTEXT: Knowledge of long-term persistence with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy is limited because previous studies have observed patients for short periods of time, in closely monitored clinical trials, or in other unrepresentative settings. OBJECTIVE: To describe the patterns and predictors of long-term persistence with statin therapy in an elderly US population. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study including 34 501 enrollees in the New Jersey Medicaid and Pharmaceutical Assistance to the Aged and Disabled programs who were 65 years of age and older, initiated statin treatment between 1990 and 1998, and who were followed up until death, disenrollment, or December 31, 1999. MAIN OUTCOME MEASURES: Proportion of days covered (PDC) by a statin in each quarter during the first year of therapy and every 6 months thereafter; predictors of suboptimal persistence during each interval (PDC <80%) were identified using generalized linear models for repeated measures. RESULTS: The mean PDC was 79% in the first 3 months of treatment, 56% in the second quarter, and 42% after 120 months. Only 1 patient in 4 maintained a PDC of at least 80% after 5 years. The proportion of patients with a PDC less than 80% increased in a log-linear manner, comprising 40%, 61%, and 68% of the cohort after 3, 12, and 120 months, respectively. Independent predictors of poor long-term persistence included nonwhite race, lower income, older age, less cardiovascular morbidity at initiation of therapy, depression, dementia, and occurrence of coronary heart disease events after starting treatment. Patients who initiated therapy between 1996-1998 were 21% to 25% more likely to have a PDC of at least 80% than those who started in 1990. CONCLUSIONS: Persistence with statin therapy in older patients declines substantially over time, with the greatest drop occurring in the first 6 months of treatment. Despite slightly better persistence among patients who began treatment in recent years, long-term use remains low. Interventions are needed early in treatment and among high-risk groups, including those who experience coronary heart disease events after initiating treatment.

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  • Predictors of non-adherence with statins include use in primary prevention rather than in patients with disease or multiple risk factors, lower income, being elderly, complex polypharmacy, cost, forgetfulness due to a lack of symptoms and psychological co-morbidities.

    “Predictors of non-adherence with statins have been identified 450,472e474 and include their use in individuals for primary prevention as compared with their use in patients with disease or with multiple risk factors, lower income, being elderly, complex polypharmacy, cost and forgetfulness due to a lack of symptoms and psychological co-morbidities.”

    From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [450]

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Authors
Benner, J. S.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Benner, Joshua S.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2002-07-24
Volume
288
Issue
4
Pages
455
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.288.4.455
OpenAlex
W2058647728
Cited by
1,232
References
36
Citations by year
2026: 5 · 2025: 17 · 2024: 23 · 2023: 27 · 2022: 39 · 2021: 31 · 2020: 35 · 2019: 57 · 2018: 44 · 2017: 54 · 2016: 77 · 2015: 65 · 2014: 76 · 2013: 64 · 2012: 69
FWCI
37.95
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute on Aging (AG-18833, AG-18935)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
statin therapy, treatment persistence, long-term medication adherence, elderly patients, statins, proportion of days covered, predictors of non-adherence, depression, dementia, Medicaid enrollees, older adults
MeSH terms
Aged, Aged, 80 and over, Hypolipidemic Agents, Coronary Disease, Female, Follow-Up Studies, Humans, Male, Patient Compliance, Retrospective Studies, Time, Multivariate Analysis, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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