Adherence and chemoprevention in major cardiovascular disease: a simulation study of the benefits of additional use of statins
Journal of Epidemiology and Community Health
In everyday practice, adherence with preventive medications for cardiovascular disease (CVD) is lower than in clinical trials and appears to decline to around 50% by around 5 years. The UK body for the evaluation of health technologies, NICE, currently recommends that persons with a greater than 20% 10 year risk of incident cardiovascular disease receive statins. Methods Publications on adherence with statin medication in clinical trials and in normal practice were systematically reviewed. We
... ally reviewed. We used data on CVD-free members of a large Southern Hemisphere cohort study to simulate the expected benefits of contrasting strategies to increase the use of statins. Risks of incident CVD and CVD death were estimated using the equations of Anderson et al. Results A strategy to enhance statin adherence among cohort members meeting NICE statin prescribing guidelines resulted in about twice as large a reduction in the aggregate risk of CVD death as did a strategy to lower treatment thresholds. Conclusions The benefits from increased spend on statin medication will be much greater if it results from enhanced adherence rather than from a lowering of the medication threshold. 1. Studies of adherence in the community setting are shown in table 2. * Studies of those with new and existing prescriptions for Statin medication for primary or secondary prevention outside the clinical trial setting.