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Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients

Sayed H Naderi1, Jonathan P Bestwick, David S Wald

  • 1Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, Charterhouse Square, UK.

The American Journal of Medicine
|July 4, 2012
PubMed

Insights

Adherence to coronary heart disease preventive medications is poor, with only 57% of patients consistently refilling prescriptions. Adherence is higher in secondary prevention (66%) than primary prevention (50%).

Area of Science:

  • Cardiovascular medicine
  • Pharmacology
  • Public health

Background:

  • Combination therapy including aspirin, statins, and blood pressure-lowering drugs significantly reduces coronary heart disease (CHD) risk.
  • Long-term, indefinite treatment is crucial for realizing the full preventive benefits of these medications.
  • Understanding adherence patterns is vital for optimizing CHD prevention strategies.

Purpose of the Study:

  • To estimate adherence rates to CHD preventive medications across different drug classes.
  • To compare adherence between primary prevention (no prior myocardial infarction) and secondary prevention (post-myocardial infarction) populations.
  • To identify factors influencing adherence, such as drug class, age, payment, and treatment duration.

Main Methods:

  • A meta-analysis of 20 studies involving 376,162 patients.
  • Adherence was assessed via prescription refill frequency for 7 drug classes: aspirin, ACE inhibitors, ARBs, beta-blockers, calcium-channel blockers, thiazides, and statins.
  • Meta-regression was employed to analyze the impact of patient age, payment status, and treatment duration on adherence.

Main Results:

  • Overall adherence across all studies was 57% after a median of 24 months.
  • Adherence was significantly higher in secondary prevention (66%) compared to primary prevention (50%).
  • In primary prevention, adherence was lower for thiazides (42%) than for angiotensin receptor blockers (61%). Adherence decreased over time (0.15% per month) and was not influenced by age or payment.

Conclusions:

  • Adherence to medications for CHD prevention is generally poor.
  • Adherence differences between drug classes were minimal, suggesting side effects are not the primary driver of non-adherence.
  • General strategies, rather than drug-specific approaches, are likely needed to improve patient adherence to preventive therapies.
Abstract

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