Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis
Open accessAbstract
Background Older people (aged ≥ 65 years) have distinctive challenges with medication adherence. However, adherence and persistence patterns among older statin users have not been comprehensively reviewed. Methods As part of a broader systematic review, we searched Medline, Embase, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effects, CENTRAL, and the National Health Service Economic Evaluation Database through December 2016 for English articles reporting adherence and/or persistence among older statin users. Data were analyzed via descriptive methods and meta-analysis using random-effect modeling. Results Data from more than 3 million older statin users in 82 studies conducted in over 40 countries were analyzed. At 1-year follow-up, 59.7% (primary prevention 47.9%; secondary prevention 62.3%) of users were adherent (medication possession ratio [MPR] or proportion of days covered [PDC] ≥ 80%). For both primary and secondary prevention subjects, 1-year adherence was worse among individuals aged more than 75 years than those aged 65-75 years. At 3 and ≥10 years, 55.3% and 28.4% of users were adherent, respectively. The proportion of users persistent at 1-year was 76.7% (primary prevention 76.0%; secondary prevention 82.6%). Additionally, 68.1% and 61.2% of users were persistent at 2 and 4 years, respectively. Among new statin users, 48.2% were nonadherent and 23.9% discontinued within the first year. The proportion of statin users who were adherent based on self-report…
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A random-effects model using a generalized linear mixed model was employed for pooling studies.
“Given the anticipated statistical heterogeneity, consistent with previous adherence studies,23, 24, 25 we employed a random-effects model using a generalized linear mixed model for pooling studies.”
From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [24]
Cites
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“However, in older patients, adherence to medication is particularly challenging due to factors such as polypharmacy and increased susceptibility to adverse events (10).”
BackgroundHow do we improve patient compliance and adherence to long-term statin therapy?
Maningat, P., Gordon, B. R., & Breslow, J. L. (2013) · Current Atherosclerosis Reports · doi:10.1007/s11883-012-0291-7 · Cited by 208 · see citing works
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Ofori‐Asenso, R., Sahle, B. W., Chin, K. L., Mazidi, M., Ademi, Z., De Bruin, M. L., & Liew, D. (2021) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3350 · Cited by 44 · see citing works
Self-citationGadowski, A. M., Nanayakkara, N., Heritier, S., Magliano, D. J., Shaw, J. E., Curtis, A. J., Zoungas, S., & Owen, A. J. (2019) · Nutrients · doi:10.3390/nu11081858 · Cited by 8 · see citing works
Self-citationAdherence to PCSK9 Inhibitors in Clinical Practice
Blais, J. E., Zhong, W., Li, C. Y. V., Kongkaew, C., & Chan, A. H. Y. (2026) · JACC: Advances · doi:10.1016/j.jacadv.2026.102733 · Cited by 7 · see citing works
- Authors
- Ofori-Asenso, R., Jakhu, A., Zomer, E., Curtis, A. J., Korhonen, M. J., Nelson, M., Gambhir, M., Tonkin, A., Liew, D., & Zoungas, S.
- Affiliations
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
- Monash University (AU)
- University of Tasmania (AU)
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
- Monash Health (AU)
- Corresponding author
- Zoungas, Sophia
- ORCID
- Venue
- The Journals of Gerontology: Series A
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-09-02
- Volume
- 73
- Issue
- 6
- Pages
- 813-819
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2752445709
- Cited by
- 118
- References
- 6
- Citations by year
- 2026: 9 · 2025: 19 · 2024: 14 · 2023: 10 · 2022: 6 · 2021: 21 · 2020: 12 · 2019: 13 · 2018: 13 · 2017: 1
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- UTAS Research Repository (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- National Health and Medical Research Council
- 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
- statins, medication adherence, treatment persistence, older adults, medication possession ratio, proportion of days covered, primary prevention, secondary prevention, statin discontinuation, cardiovascular disease, self-reported adherence
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence
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