A Systematic Review Uncovering Modifiable Influences on Statin Adherence

Area of Science:

• Cardiovascular Medicine
• Health Psychology
• Evidence Synthesis

Background:

• Statins significantly reduce cardiovascular disease (CVD) risk, yet global adherence rates are suboptimal.
• Existing reviews on statin adherence have limitations, including inadequate integration of qualitative and quantitative data.
• Identifying modifiable barriers and facilitators is crucial for improving patient adherence and CVD outcomes.

Purpose of the Study:

• To systematically review and synthesize modifiable barriers and facilitators influencing statin adherence.
• To utilize the Theoretical Domains Framework (TDF) for a structured analysis of adherence factors.
• To identify evidence gaps, particularly concerning underrepresented patient populations.

Main Methods:

• Comprehensive systematic literature search across Embase, MEDLINE, PsycINFO, and CINAHL (1998-2023).
• Data extraction and coding according to TDF domains, noting evidence type (qualitative/quantitative).
• Synthesis of findings to identify key influences on statin adherence across diverse patient groups.

Main Results:

• Seventy studies from 20 countries were included; only one focused on ethnic minorities.
• Key TDF domains influencing adherence included 'Beliefs about Consequences', 'Knowledge', 'Environmental Context and Resources', and 'Social Influences'.
• Factors like disease knowledge, perceived threat, perceived benefits, and patient-provider communication were significant; side effects showed inconsistent associations.

Conclusions:

• This review identified specific, modifiable factors that can enhance statin adherence.
• Interventions should focus on improving patient knowledge, addressing beliefs about consequences, and leveraging social support.
• Future research must prioritize underrepresented groups to develop inclusive and effective adherence strategies.