A Systematic Review and Meta-analysis of the Factors Associated with Nonadherence and Discontinuation of Statins among People Aged ≥65 Years

Richard Ofori-Asenso, Avtar Jakhu, Andrea J Curtis, Ella Zomer, Manoj Gambhir, Maarit Jaana Korhonen, Mark Nelson, Andrew Tonkin, Danny Liew, Sophia Zoungas

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background
Older individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed.

Methods
We conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques.

Results
Forty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39–1.98), female gender (OR 1.08, 95% CI 1.03–1.13), current smoker (OR 1.12, 95% CI 1.03–1.21), higher copayments (OR 1.38, 95% CI 1.25–1.52), new user (OR 1.58, 95% CI 1.21–2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06–1.09), primary prevention (OR 1.49, 95% CI 1.40–1.59), having respiratory disorders (OR 1.17, 95% CI 1.12–1.23) or depression (OR 1.11, 95% CI 1.06–1.16), and not having renal disease (OR 1.09, 95% CI 1.04–1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06–1.36), current smoker (OR 1.14, 95% CI 1.06–1.23), higher copayment (OR 1.61, 95% CI 1.53–1.70), higher number of medications (OR 1.04, 95% CI 1.01–1.06), presence of dementia (OR 1.18, 95% CI 1.02–1.36), cancer (OR 1.22, 95% CI 1.11–1.33) or respiratory disorders (OR 1.19, 95% CI 1.05–1.34), primary prevention (OR 1.66, 95% CI 1.24–2.22), and not having hypertension (OR 1.13, 95% CI 1.07–1.20) or diabetes (OR 1.09, 95% CI 1.04–1.15).

Conclusion
Interventions that target potentially modifiable factors including financial and social barriers, patients’ perceptions about disease risk as well as polypharmacy may improve statin use in the older population.
Original languageEnglish
Pages (from-to)798-805
Number of pages8
JournalJournal of Gerontology Series A: Biological Sciences and Medical Sciences
Volume73
Issue number6
DOIs
Publication statusPublished - 9 May 2018

Keywords

  • Adherence
  • HMG-CoA reductase inhibitors
  • Persistence
  • Risk indicators

Cite this

@article{5cc01714fed743dd9265a0aeff4cc5b4,
title = "A Systematic Review and Meta-analysis of the Factors Associated with Nonadherence and Discontinuation of Statins among People Aged ≥65 Years",
abstract = "BackgroundOlder individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed.MethodsWe conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques.ResultsForty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95{\%} confidence interval [CI] 1.39–1.98), female gender (OR 1.08, 95{\%} CI 1.03–1.13), current smoker (OR 1.12, 95{\%} CI 1.03–1.21), higher copayments (OR 1.38, 95{\%} CI 1.25–1.52), new user (OR 1.58, 95{\%} CI 1.21–2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95{\%} CI 1.06–1.09), primary prevention (OR 1.49, 95{\%} CI 1.40–1.59), having respiratory disorders (OR 1.17, 95{\%} CI 1.12–1.23) or depression (OR 1.11, 95{\%} CI 1.06–1.16), and not having renal disease (OR 1.09, 95{\%} CI 1.04–1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95{\%} CI 1.06–1.36), current smoker (OR 1.14, 95{\%} CI 1.06–1.23), higher copayment (OR 1.61, 95{\%} CI 1.53–1.70), higher number of medications (OR 1.04, 95{\%} CI 1.01–1.06), presence of dementia (OR 1.18, 95{\%} CI 1.02–1.36), cancer (OR 1.22, 95{\%} CI 1.11–1.33) or respiratory disorders (OR 1.19, 95{\%} CI 1.05–1.34), primary prevention (OR 1.66, 95{\%} CI 1.24–2.22), and not having hypertension (OR 1.13, 95{\%} CI 1.07–1.20) or diabetes (OR 1.09, 95{\%} CI 1.04–1.15).ConclusionInterventions that target potentially modifiable factors including financial and social barriers, patients’ perceptions about disease risk as well as polypharmacy may improve statin use in the older population.",
keywords = "Adherence, HMG-CoA reductase inhibitors, Persistence, Risk indicators",
author = "Richard Ofori-Asenso and Avtar Jakhu and Curtis, {Andrea J} and Ella Zomer and Manoj Gambhir and Korhonen, {Maarit Jaana} and Mark Nelson and Andrew Tonkin and Danny Liew and Sophia Zoungas",
year = "2018",
month = "5",
day = "9",
doi = "10.1093/gerona/glx256",
language = "English",
volume = "73",
pages = "798--805",
journal = "Journal of Gerontology Series A: Biological Sciences and Medical Sciences",
issn = "1079-5006",
publisher = "Oxford University Press",
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TY - JOUR

T1 - A Systematic Review and Meta-analysis of the Factors Associated with Nonadherence and Discontinuation of Statins among People Aged ≥65 Years

AU - Ofori-Asenso, Richard

AU - Jakhu, Avtar

AU - Curtis, Andrea J

AU - Zomer, Ella

AU - Gambhir, Manoj

AU - Korhonen, Maarit Jaana

AU - Nelson, Mark

AU - Tonkin, Andrew

AU - Liew, Danny

AU - Zoungas, Sophia

PY - 2018/5/9

Y1 - 2018/5/9

N2 - BackgroundOlder individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed.MethodsWe conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques.ResultsForty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39–1.98), female gender (OR 1.08, 95% CI 1.03–1.13), current smoker (OR 1.12, 95% CI 1.03–1.21), higher copayments (OR 1.38, 95% CI 1.25–1.52), new user (OR 1.58, 95% CI 1.21–2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06–1.09), primary prevention (OR 1.49, 95% CI 1.40–1.59), having respiratory disorders (OR 1.17, 95% CI 1.12–1.23) or depression (OR 1.11, 95% CI 1.06–1.16), and not having renal disease (OR 1.09, 95% CI 1.04–1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06–1.36), current smoker (OR 1.14, 95% CI 1.06–1.23), higher copayment (OR 1.61, 95% CI 1.53–1.70), higher number of medications (OR 1.04, 95% CI 1.01–1.06), presence of dementia (OR 1.18, 95% CI 1.02–1.36), cancer (OR 1.22, 95% CI 1.11–1.33) or respiratory disorders (OR 1.19, 95% CI 1.05–1.34), primary prevention (OR 1.66, 95% CI 1.24–2.22), and not having hypertension (OR 1.13, 95% CI 1.07–1.20) or diabetes (OR 1.09, 95% CI 1.04–1.15).ConclusionInterventions that target potentially modifiable factors including financial and social barriers, patients’ perceptions about disease risk as well as polypharmacy may improve statin use in the older population.

AB - BackgroundOlder individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed.MethodsWe conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques.ResultsForty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39–1.98), female gender (OR 1.08, 95% CI 1.03–1.13), current smoker (OR 1.12, 95% CI 1.03–1.21), higher copayments (OR 1.38, 95% CI 1.25–1.52), new user (OR 1.58, 95% CI 1.21–2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06–1.09), primary prevention (OR 1.49, 95% CI 1.40–1.59), having respiratory disorders (OR 1.17, 95% CI 1.12–1.23) or depression (OR 1.11, 95% CI 1.06–1.16), and not having renal disease (OR 1.09, 95% CI 1.04–1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06–1.36), current smoker (OR 1.14, 95% CI 1.06–1.23), higher copayment (OR 1.61, 95% CI 1.53–1.70), higher number of medications (OR 1.04, 95% CI 1.01–1.06), presence of dementia (OR 1.18, 95% CI 1.02–1.36), cancer (OR 1.22, 95% CI 1.11–1.33) or respiratory disorders (OR 1.19, 95% CI 1.05–1.34), primary prevention (OR 1.66, 95% CI 1.24–2.22), and not having hypertension (OR 1.13, 95% CI 1.07–1.20) or diabetes (OR 1.09, 95% CI 1.04–1.15).ConclusionInterventions that target potentially modifiable factors including financial and social barriers, patients’ perceptions about disease risk as well as polypharmacy may improve statin use in the older population.

KW - Adherence

KW - HMG-CoA reductase inhibitors

KW - Persistence

KW - Risk indicators

UR - http://www.scopus.com/inward/record.url?scp=85047081931&partnerID=8YFLogxK

U2 - 10.1093/gerona/glx256

DO - 10.1093/gerona/glx256

M3 - Review Article

VL - 73

SP - 798

EP - 805

JO - Journal of Gerontology Series A: Biological Sciences and Medical Sciences

JF - Journal of Gerontology Series A: Biological Sciences and Medical Sciences

SN - 1079-5006

IS - 6

ER -