Association between adherence to statin therapy and lipid control in Hong Kong Chinese patients at high risk of coronary heart disease

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Abstract
Aims To examine the pattern of adherence to statin therapy and to determine the association of adherence to statin therapy and the control of serum low‐density lipoprotein (LDL)‐cholesterol in a cohort of Hong Kong Chinese patients at high risk of coronary heart disease (CHD). Methods This was a prospective observational cohort study conducted at the outpatient clinics of a public teaching hospital in Hong Kong. Patients at high risk of CHD who had been initiated on statin monotherapy for < 12 months were recruited. The statin prescription was dispensed in a bottle with the Medication Event Monitoring System (MEMS). Adherence was assessed in two dimensions: dose‐count was defined as the percentage of doses taken, and dose‐time was defined as the percentage of doses taken within the suggested time interval. Lipid profiles were obtained at baseline and during two follow‐up visits at month 3 and month 6. Results Eighty‐three patients completed the study. The median adherence to dose‐count and to dose‐time were 95% (25‐75th percentile = 87–99%) and 78% (25–75th percentile = 17–92%), respectively. Both dose‐count and dose‐time adherence declined slightly over the first 6 months of therapy. Living with family [relative risk (RR) = 0.79, 95% confidence interval (CI) 0.63, 0.91] and duration of therapy (RR = 0.99, 95% CI 0.98, 1.00) were negative predictors while number of family members (among those living with family) (RR = 1.05, 95% CI 1.00, 1.08) was a positive predictor for adherence to dose‐count. Monthly household income (RR = 1.01, 95% CI 1.00, 1.02) and angina (RR = 1.29, 95% CI 1.05, 1.58) were positive predictors while living with family (RR = 0.74, 95% CI 0.55, 0.90) was a negative predictor for dose‐time adherence. Percent reduction in serum LDL‐cholesterol was correlated to dose‐count (P < 0.001) and dose‐time (P = 0.047) adherence. Statistically significant correlations were observed between adherence to dose‐count and LDL reduction (R2 = 0.130; P = 0.001), and between dose‐time adherence and LDL reduction (R2 = 0.048; P = 0.047). Conclusion High adherence to statin therapy was found in a cohort of Chinese patients at high risk of CHD and the adherence declined slightly over time. A weak association between adherence to statin dose‐count and LDL reduction and a marginal association between dose‐time adherence and LDL reduction were observed.

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