Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study
Open accessAbstract
Background: In the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD). Aim: We examined risk factors for medication adherence and the relationship between adherence and levels of CVD risk factors among older participants with hypertension, dyslipidaemia and diabetes in the Framingham Heart Study. Methods: The four‐item Morisky Medication Adherence Scale was administered to 1559 participants, median age 70 years, 53% women. We created an adherence score, ranging from 0 to 4, with low adherence defined as a score ≥2. CVD risk factors were assessed using standard protocols. Cognition was measured using the Mini‐Mental State Examination (MMSE) and depressive symptoms were measured using the Center for Epidemiologic Studies of Depression (CES‐D) scale. Results: Among participants who self‐reported taking antihypertensive, lipid‐lowering and/or hyperglycaemic medication(s), 12% (n = 191) had low medication adherence. The risk of low adherence increased by 45% (95% confidence interval (CI): 25–68%, P < 0.001) per five‐unit increase in CES‐D score. In participants taking antihypertensive medication (n = 1017), low adherence was associated with higher mean diastolic blood pressure (73 mmHg, 95% CI: 71–75 vs 71 mmHg, 95% CI: 70–71; P = 0.04) after adjusting for covariates. Among participants taking lipid‐lowering medication (n = 937), low adherence was associated with higher mean low‐density lipoprotein cholesterol (92 mg/dL, 95% CI: 87–96 vs 86 mg/dL, 95% CI: 84–88; P = 0.03). Low adherence was not associated with fasting plasma glucose (P = 0.10) or haemoglobin A1c (P = 0.68) in the subgroup of participants (n = 192) taking hypoglycaemic medication. Conclusions: Depressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older‐aged adults.
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Assessing depression and depressive symptoms is important in patients with CVD and T2DM, as adequate treatment improves adherence.
“Assessing depression and depressive symptoms is important in patients with CVD and T2DM, as adequate treatment improves adherence.376,377”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [377]
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2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
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2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
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- Authors
- Hennein, R., Hwang, S., Au, R., Levy, D., Muntner, P., Fox, C. S., & Ma, J.
- Affiliations
- National Institutes of Health (US)
- Boston University (US)
- University of Alabama at Birmingham (US)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Corresponding author
- Hennein, Rachel
- Venue
- Internal Medicine Journal
- Publisher
- Wiley
- Published
- 2018-04
- Volume
- 48
- Issue
- 4
- Pages
- 414-421
- ISSN
- 1444-0903 (ISSN-L)
- 1445-5994
- PMC
- PMC5889324
- OpenAlex
- W2771663153
- Cited by
- 67
- References
- 48
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 9 · 2023: 5 · 2022: 14 · 2021: 13 · 2020: 7 · 2019: 6 · 2018: 2
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Internal Medicine Journal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HHSN2682015000011)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- medication adherence, cardiovascular risk factors, older adults, depressive symptoms, cognitive impairment, hypertension, dyslipidemia, diabetes mellitus, antihypertensive drugs, lipid-lowering drugs, blood pressure control, LDL cholesterol, Morisky Medication Adherence Scale
- MeSH terms
- Aged, Antihypertensive Agents, Hypolipidemic Agents, Cardiovascular Diseases, Cross-Sectional Studies, Depression, Female, Humans, Hypoglycemic Agents, Male, Middle Aged, Risk Factors, Cohort Studies, Medication Adherence, Self Report
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