Interesting article on Statin Compliance



A

Anonymous

Guest
I thought this article on statin compliance might be interesting.

Bill
_____________________________________

One-in-Four Patients on a Statin Seen to Be Non-Compliant

By Richard Woodman

LONDON (Reuters Health) Jan 13 - Many patients with high cholesterol don't take their statin
medication as prescribed, according to a British study published in the Pharmaceutical Journal.

Researchers in Liverpool studied the medical records of 12700 patients at a large general practice
in the city and found that 1010 persons were prescribed a statin -- mainly simvastatin or
pravastatin -- between 1991 and 2003.

Analysis showed that a quarter (215) of the 869 patients who met the study inclusion criteria were
non-compliant with therapy and that 654 patients were compliant.

Of the study population, 74 patients discontinued statin therapy altogether, usually within the
first two years. Other patients who took their therapy less than 80% of the time were also judged to
be non-compliant.

Compliance with therapy was associated with a statistically significant 56% relative reduction in
CHD mortality and a 63% relative risk reduction in non-cardiovascular mortality.

The risk of dying from a non-cardiovascular cause was nearly four times higher in the non-compliant
group. The reasons were unclear but Nicola Howell and colleagues at Liverpool John Moores University
said it was interesting to note that phase ll trials were investigating the benefits of statins as
anti-cancer agents.

The authors said there was a need for compliance-enhancing initiatives such as regular cholesterol
monitoring, which was shown in the study to be a statistically significant predictor of patient
compliance.

Pharm J 2004:272:23-26.

http://www.medscape.com/viewarticle/467122_print
 
N

Nigel

Guest
news:[email protected]:

> I thought this article on statin compliance might be interesting.
>
> Bill
> _____________________________________
>
>
>
>
> One-in-Four Patients on a Statin Seen to Be Non-Compliant
>
>

This is not a problem specific to statins. Compliance for many therapies is low.

Actually, three quarters sounds like a high compliance rate considering that a person doesn't feel
sick if they don't take the drug. As reported by patients, compliance was only 37% in:

Cheng JW, Kalis MM, Feifer Pharmacotherapy. 2001 Jul; 21(7): 828-41 Patient-reported adherence to
guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure

I think the only place you truly see high levels of compliance is in clinical trials in which dose
counts are done.
 
J

Jim Chinnis

Guest
Nigel <I.don'[email protected]> wrote in part:

>news:[email protected]:
>
>> I thought this article on statin compliance might be interesting.
>>
>> Bill
>> _____________________________________
>>
>>
>>
>>
>> One-in-Four Patients on a Statin Seen to Be Non-Compliant
>>
>>
>
>This is not a problem specific to statins. Compliance for many therapies is low.
>
>Actually, three quarters sounds like a high compliance rate considering that a person doesn't feel
>sick if they don't take the drug. As reported by patients, compliance was only 37% in:
>
>Cheng JW, Kalis MM, Feifer Pharmacotherapy. 2001 Jul; 21(7): 828-41 Patient-reported adherence to
>guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and
>Treatment of High Blood Pressure
>
>I think the only place you truly see high levels of compliance is in clinical trials in which dose
>counts are done.

Even there, I wonder how many patients flush their pills...

I recall reading some theories that (small) advantages in surgical treatment of coronary artery
disease might be completely explained by a tendency for those traumatized patients to have somewhat
higher levels of compliance with their drug prescriptions.
--
Jim Chinnis Warrenton, Virginia, USA
 
A

Anonymous

Guest
"Nigel" <I.don'[email protected]> wrote in message
news:[email protected]...

> news:[email protected]:
>
> > I thought this article on statin compliance might be interesting.
> >
> > Bill
> > _____________________________________
> >
> >
> >
> >
> > One-in-Four Patients on a Statin Seen to Be Non-Compliant
> >
> >
>
> This is not a problem specific to statins. Compliance for many therapies is low.
>
> Actually, three quarters sounds like a high compliance rate considering that a person doesn't feel
> sick if they don't take the drug. As reported by patients, compliance was only 37% in:
>
> Cheng JW, Kalis MM, Feifer Pharmacotherapy. 2001 Jul; 21(7): 828-41 Patient-reported adherence to
> guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and
> Treatment of High Blood Pressure
>
> I think the only place you truly see high levels of compliance is in clinical trials in which dose
> counts are done.

But I found the more interesting point to be the impact of non-compliance.

Bill
 
J

Jim Chinnis

Guest
>But I found the more interesting point to be the impact of non-compliance.

I found that very interesting, too. But you have to interpret that comparison with caution. The
patients who choose not to comply with statin dosing may also not comply with diets, other drugs,
non-smoking, exercise, etc. That's probably why their relative risk is even poorer than controlled
trials would suggest.
--
Jim Chinnis Warrenton, Virginia, USA
 
T

Thorsten Schier

Guest
Bill schrieb:
>
> "Nigel" <I.don'[email protected]> wrote in message
> news:[email protected]...

> > news:[email protected]:
> >
> > > I thought this article on statin compliance might be interesting.
> > >
> > > Bill
> > > _____________________________________
> > >
> > >
> > >
> > >
> > > One-in-Four Patients on a Statin Seen to Be Non-Compliant
> > >
> > >
> >
> > This is not a problem specific to statins. Compliance for many therapies is low.
> >
> > Actually, three quarters sounds like a high compliance rate considering that a person doesn't
> > feel sick if they don't take the drug. As reported by patients, compliance was only 37% in:
> >
> > Cheng JW, Kalis MM, Feifer Pharmacotherapy. 2001 Jul; 21(7): 828-41 Patient-reported adherence
> > to guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and
> > Treatment of High Blood Pressure
> >
> > I think the only place you truly see high levels of compliance is in clinical trials in which
> > dose counts are done.
>
> But I found the more interesting point to be the impact of non-compliance.
>

It is an association, we don't know whether the differences in mortality are the impact of non-
compliance or due to other causes.

Here is the text of thy study:

www.pjonline.com/pdf/papers/pj_20040110_compliance.pdf

The difference in all-cause mortality was largely due to the different death rates in non-
cardiovascular deaths (8 in the C-group to 7 in the non-C-group).

The difference for all cardiovascular causes did not reach significance (16 to 7).

Considering that statins are prescribed for cardiovascular causes, you would have expected it the
other way round.

Perhaps this can partly be explained when we assume that for some of these deaths not the non-
compliance was the cause of death, but that the real cause of death caused the non-compliance. For
example if someone is diagnosed with cancer, this might become a more pressing concern than high
cholesterol, so the statin might be discontinued. Or a person has alzheimer or dementia and is
therefor more prone to forget to get a new prescription of the statin, such person will likely also
be at higher risk for death, independent of whether they take the statin or not. And last but not
least: a person who does not take his statin might also be non-compliant when it comes to other
medications or treatments, in which case the death might be due to non-compliance in regard to this
other treatments.

Thorsten

--
"Nothing in biology makes sense, except in the light of evolution"

(Theodosius Dobzhansky)
 
A

Anonymous

Guest
"Jim Chinnis" <[email protected]> wrote in message
news:[email protected]...

>
> >But I found the more interesting point to be the impact of non-compliance.
>
> I found that very interesting, too. But you have to interpret that
comparison
> with caution. The patients who choose not to comply with statin dosing may also not comply with
> diets, other drugs, non-smoking, exercise, etc. That's probably why their relative risk is even
> poorer than controlled trials would suggest.
> --
> Jim Chinnis Warrenton, Virginia, USA

Agreed

Bill
 
N

Nigel

Guest
Thorsten Schier <[email protected]> wrote in
news:[email protected]:

> Bill schrieb:
>>
>> But I found the more interesting point to be the impact of non-compliance.
>>
>
> It is an association, we don't know whether the differences in mortality are the impact of non-
> compliance or due to other causes.
>
> Here is the text of thy study:
>
> www.pjonline.com/pdf/papers/pj_20040110_compliance.pdf
>

I love the little boxes BMJ puts at the end of articles that say *what is already known on this
topic* and *what this paper adds*.

In this case it might say something like this.

What is already known on this topic: Patients that do not comply with therapies known to improve
morbidity and mortality have higher morbidity and mortality rates.

Most patients are not compliant.

What this study adds: Patients that do not comply with statin treatment have higher mortality.
 
D

Dr. Andrew B. C

Guest
Thorsten Schier <[email protected]> wrote in message news:<[email protected]>...
> Bill schrieb:
> >
> > "Nigel" <I.don'[email protected]> wrote in message
> > news:[email protected]...

> > > news:[email protected]:
> > >
> > > > I thought this article on statin compliance might be interesting.
> > > >
> > > > Bill
> > > > _____________________________________
> > > >
> > > >
> > > >
> > > >
> > > > One-in-Four Patients on a Statin Seen to Be Non-Compliant
> > > >
> > > >
> > >
> > > This is not a problem specific to statins. Compliance for many therapies is low.

Correct. Especially if the medication(s) is costly.

> > >
> > > Actually, three quarters sounds like a high compliance rate considering that a person doesn't
> > > feel sick if they don't take the drug. As reported by patients, compliance was only 37% in:
> > >
> > > Cheng JW, Kalis MM, Feifer Pharmacotherapy. 2001 Jul; 21(7): 828-41 Patient-reported adherence
> > > to guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and
> > > Treatment of High Blood Pressure
> > >
> > > I think the only place you truly see high levels of compliance is in clinical trials in which
> > > dose counts are done.

Or when the medication is very inexpensive.

> > But I found the more interesting point to be the impact of non-compliance.
> >
>
> It is an association, we don't know whether the differences in mortality are the impact of non-
> compliance or due to other causes.

Results from randomized double-blind placebo control prospective trials like LIPID, 4S, CARE,
WOSCOPS, AFCAPS/TexCAPs, and HPS helps us *know* that the differences in mortality are likely the
impact of non-compliance.

> Here is the text of thy study:
>
> www.pjonline.com/pdf/papers/pj_20040110_compliance.pdf

Thanks for the link, Thorsten.

> The difference in all-cause mortality was largely due to the different death rates in non-
> cardiovascular deaths (8 in the C-group to 7 in the non-C-group).

Not really. If you look at the methods more closely, you should note that the cause of death was
determined by reviewing death certificates. What they called cardiovascular deaths were actually
deaths from a documented myocardial infarction or stroke. Many "non-cardiovascular" deaths may have
been from *undiagnosed* myocardial infarctions, strokes, or other catastrophic ischemic/vascular
events that would have been characterized as cardiovascular had an autopsy been done.

Moreover, a big part of all-cause mortality was actually due to different rates of MI deaths (1.2%
or 8/654 in the C-group and 2.8% or
6/215 in the non-C-group).

> The difference for all cardiovascular causes did not reach significance (16 to 7).

Probably because of the problem with looking only at death certificates (not autopsies) as
described above.

This reminds me of the death certificate of the late Dr. Bob Atkins. Cause of death was reportedly
from slipping on ice. Had Dr. Atkins been enrolled in this study, his death would have been in the
non-cardiovascular column. Given his past history of sudden cardiac death and his high-fat diet
lifestyle, an autopsy probably would have revealed a cardiovascular cause.

> Considering that statins are prescribed for cardiovascular causes, you would have expected it the
> other way round.

The difference in MI death rates was statistically significant.

> Perhaps this can partly be explained when we assume that for some of these deaths not the non-
> compliance was the cause of death, but that the real cause of death caused the non-compliance. For
> example if someone is diagnosed with cancer, this might become a more pressing concern than high
> cholesterol, so the statin might be discontinued.

This typically does not happen. The most common reason for not taking a prescribed statin is the
cost of the statin, ime.

> Or a person has alzheimer or dementia and is therefor more prone to forget to get a new
> prescription of the statin, such person will likely also be at higher risk for death, independent
> of whether they take the statin or not.

Demented patients typically end up having a caregiver that supervises all aspects of care. I suspect
such patients would have compliance rates that approach 100%.

> And last but not least: a person who does not take his statin might also be non-compliant when it
> comes to other medications or treatments, in which case the death might be due to non-compliance
> in regard to this other treatments.

This kind of across-the-board non-compliance would also typically mean being lost to doctor follow-
up (ie no enrollment in the study in the first place).

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com
 
B

Badant

Guest
Thorsten Schier <[email protected]> wrote in message news:<[email protected]>...
> Bill schrieb:
> >
> > "Nigel" <I.don'[email protected]> wrote in message
> > news:[email protected]...

> > > news:[email protected]:
> > >
> > > > I thought this article on statin compliance might be interesting.
> > > >
> > > > Bill
> > > > _____________________________________
> > > >
> > > >
> > > >
> > > >
> > > > One-in-Four Patients on a Statin Seen to Be Non-Compliant
> > > >
> > > >
> > >
> > > This is not a problem specific to statins. Compliance for many therapies is low.
> > >
> > > Actually, three quarters sounds like a high compliance rate considering that a person doesn't
> > > feel sick if they don't take the drug. As reported by patients, compliance was only 37% in:
> > >
> > > Cheng JW, Kalis MM, Feifer Pharmacotherapy. 2001 Jul; 21(7): 828-41 Patient-reported adherence
> > > to guidelines of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and
> > > Treatment of High Blood Pressure
> > >
> > > I think the only place you truly see high levels of compliance is in clinical trials in which
> > > dose counts are done.
> >
> > But I found the more interesting point to be the impact of non-compliance.
> >
>
> It is an association, we don't know whether the differences in mortality are the impact of non-
> compliance or due to other causes.
>
> Here is the text of thy study:
>
> www.pjonline.com/pdf/papers/pj_20040110_compliance.pdf
>
> The difference in all-cause mortality was largely due to the different death rates in non-
> cardiovascular deaths (8 in the C-group to 7 in the non-C-group).
>
> The difference for all cardiovascular causes did not reach significance (16 to 7).
>
> Considering that statins are prescribed for cardiovascular causes, you would have expected it the
> other way round.
>
> Perhaps this can partly be explained when we assume that for some of these deaths not the non-
> compliance was the cause of death, but that the real cause of death caused the non-compliance. For
> example if someone is diagnosed with cancer, this might become a more pressing concern than high
> cholesterol, so the statin might be discontinued. Or a person has alzheimer or dementia and is
> therefor more prone to forget to get a new prescription of the statin, such person will likely
> also be at higher risk for death, independent of whether they take the statin or not. And last but
> not least: a person who does not take his statin might also be non-compliant when it comes to
> other medications or treatments, in which case the death might be due to non-compliance in regard
> to this other treatments.
>
> Thorsten

Or the person might be suffering memory loss and transient global amnesia caused by statins:
http://www.spacedoc.net

Or the person might be experiencing debilitating muscle pain caused by statins:
http://www.impostertrial.com/physician.htm

B'adant
 
N

Nigel

Guest
[email protected] (Dr. Andrew B. Chung, MD/PhD) wrote in
news:[email protected]:

> Thorsten Schier <[email protected]> wrote in message news:<[email protected]>...
>> Bill schrieb:
>> >
>> > "Nigel" <I.don'[email protected]> wrote in message
>> > news:[email protected]...

>> > > news:[email protected]:
>> > >
>> > > > I thought this article on statin compliance might be interesting.
>> > > >
>> > > > Bill
>> > > > _____________________________________
>> > > >
>> > > >
>> > > >
>> > > >
>> > > > One-in-Four Patients on a Statin Seen to Be Non-Compliant
>> > > >
>> > > >
>> > >
>> > > This is not a problem specific to statins. Compliance for many therapies is low.
>
> Correct. Especially if the medication(s) is costly.
>
>> > >
>> > > Actually, three quarters sounds like a high compliance rate considering that a person doesn't
>> > > feel sick if they don't take the drug. As reported by patients, compliance was only 37% in:
>> > >
>> > > Cheng JW, Kalis MM, Feifer Pharmacotherapy. 2001 Jul; 21(7): 828-41 Patient-reported
>> > > adherence to guidelines of the Sixth Joint National Committee on Prevention, Detection,
>> > > Evaluation, and Treatment of High Blood Pressure
>> > >
>> > > I think the only place you truly see high levels of compliance is in clinical trials in which
>> > > dose counts are done.
>
> Or when the medication is very inexpensive.
>

The research on compliance with antihypertensives indicates that the greateset reasons for non-
compliance are adverse effects and convenience. Economic analysis indicates that most elderly
patients are willing to pay more out of pocket for more convenient medication.