Interventions to improve adherence to lipid-lowering medication
Open accessAbstract
BACKGROUND: Lipid-lowering drugs are widely underused, despite strong evidence indicating they improve cardiovascular end points. Poor patient adherence to a medication regimen can affect the success of lipid-lowering treatment. OBJECTIVES: To assess the effects of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and CINAHL up to 3 February 2016, and clinical trials registers (ANZCTR and ClinicalTrials.gov) up to 27 July 2016. We applied no language restrictions. SELECTION CRITERIA: We evaluated randomised controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with a variety of measurable outcomes, such as adherence to treatment and changes to serum lipid levels. Two teams of review authors independently selected the studies. DATA COLLECTION AND ANALYSIS: Three review authors extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the quality of the evidence using GRADEPro. MAIN RESULTS: For this updated review, we added 24 new studies meeting the eligibility criteria to the 11 studies from prior updates. We have therefore included 35 studies, randomising 925,171 participants. Seven studies including 11,204 individuals compared adherence rates of those in an intensification of a patient care intervention (e.g. electronic reminders, pharmacist-led interventions, healthcare professional education of patients) versus usual care over the short term (six months or less), and were pooled in a meta-analysis. Participants in the intervention group had better adherence than those receiving usual care (odds ratio (OR) 1.93, 95% confidence interval (CI) 1.29 to 2.88; 7 studies; 11,204 participants; moderate-quality evidence). A separate analysis also showed improvements in long-term adherence rates (more than six months) using intensification of care (OR 2.87, 95% CI 1.91 to 4.29; 3 studies; 663 participants; high-quality evidence). Analyses of the effect on total cholesterol and LDL-cholesterol levels also showed a positive effect of intensified interventions over both short- and long-term follow-up. Over the short term, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17 to 33.14; 4 studies; 430 participants; low-quality evidence) and LDL-cholesterol decreased by a mean of 19.51 mg/dL (95% CI 8.51 to 30.51; 3 studies; 333 participants; moderate-quality evidence). Over the long term (more than six months) total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95 to 20.19; 2 studies; 127 participants; high-quality evidence). Included studies did not report usable data for health outcome indications, adverse effects or costs/resource use, so we could not pool these outcomes. We assessed each included study for bias using methods described in the Cochrane Handbook for Systematic Reviews of Interventions. In general, the risk of bias assessment revealed a low risk of selection bias, attrition bias, and reporting bias. There was unclear risk of bias relating to blinding for most studies. AUTHORS' CONCLUSIONS: The evidence in our review demonstrates that intensification of patient care interventions improves short- and long-term medication adherence, as well as total cholesterol and LDL-cholesterol levels. Healthcare systems which can implement team-based intensification of patient care interventions may be successful in improving patient adherence rates to lipid-lowering medicines.
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van Driel et al., 2016 described 7 categories of interventions and demonstrated their potential to enhance adherence and improve clinical outcomes.
“van Driel et al., 2016 described 7 categories of interventions (simplifying drug regimen, patient education, intensified patient care, behavioural approaches, decision support systems, administrative process improvements, pharmacy-led interventions) and demonstrated their potential to enhance adherence and improve clinical outcomes.6”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [6]
The Results matrix lists the seven intervention categories. The Discussion reports improved adherence and cholesterol levels for intensified patient care, but says several other categories did not consistently improve adherence or physiological outcomes. Thus the claim overstates the evidence if it attributes demonstrated benefits to all seven categories. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe search period began in 2016 to ensure continuity with and update the previous review by van Driel et al. (2016).
“The search period began in 2016 to ensure continuity with and update the previous review by van Driel et al. (2016).6”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [6]
We adopted van Driel et al.'s, 2016 intervention categorisation for ease of comparison, which may have introduced classification biases.
“Furthermore, we adopted van Driel et al.'s, 2016 intervention categorisation for an ease of comparison,6 which may have introduced classification biases.”
From Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis (2025) · cites this paper as [6]
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Interventions to improve adherence to lipid-lowering drugs: a systematic review and meta-analysis
Yow, D. K. W., Ang, W. J., Yap, H. J., Ito, S., Liu, J., Ko, J., Tan, D. S.-Y., Lorenzatti, A., & Ang, C.-S. (2025) · eClinicalMedicine · doi:10.1016/j.eclinm.2025.103270 · Cited by 5 · see citing works
- Authors
- van Driel, M. L., Morledge, M. D., Ulep, R., Shaffer, J. P., Davies, P., & Deichmann, R.
- Affiliations
- Primary Care Clinical Unit, Faculty of Medicine; The University of Queensland; Brisbane Australia
- The University of Queensland (AU)
- University of Bristol (GB)
- Ochsner Health System (US)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2016-12-21
- Volume
- 2021
- Issue
- 3
- Pages
- CD004371-CD004371
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6464006
- OpenAlex
- W1651579527
- Cited by
- 333
- References
- 10
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 13 · 2023: 7 · 2022: 18 · 2021: 17 · 2020: 39 · 2019: 18 · 2018: 25 · 2017: 17 · 2016: 27 · 2015: 17 · 2014: 16 · 2013: 21 · 2012: 17
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- medication adherence, lipid-lowering drugs, adherence interventions, electronic reminders, pharmacist intervention, patient education, total cholesterol, LDL cholesterol, cardiovascular risk reduction, statins, ezetimibe, hypercholesterolemia, dyslipidemia, outpatient care, long-term adherence, serum lipids, cardiovascular events, quality of life
- MeSH terms
- Assessment of Medication Adherence, Adult, Hypolipidemic Agents, Cardiovascular Diseases, Cholesterol, Humans, Cholesterol, LDL, Randomized Controlled Trials as Topic, Drug Monitoring, Reminder Systems, Medication Adherence
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