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Journal Article
Meta-Analysis
Research Support, U.S. Gov't, Non-P.H.S.
Systematic Review
Interventions to Improve Statin Tolerance and Adherence in Patients at Risk for Cardiovascular Disease : A Systematic Review for the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Dyslipidemia.
Annals of Internal Medicine 2020 November 18
BACKGROUND: Strategies to improve patients' tolerance of and adherence to statins may enhance the effectiveness of dyslipidemia treatment in those at risk for cardiovascular disease (CVD).
PURPOSE: To assess the benefits and harms of interventions to improve statin adherence in patients at risk for CVD.
DATA SOURCES: MEDLINE, EMBASE, PubMed, and the Cochrane Library from December 2013 through May 2019 (English language only).
STUDY SELECTION: Systematic reviews (SRs), randomized controlled trials (RCTs), and cohort studies that addressed interventions for improving statin tolerance and adherence.
DATA EXTRACTION: One investigator abstracted data and assessed study quality, and a second investigator checked abstractions and assessments for accuracy.
DATA SYNTHESIS: One SR, 1 RCT, and 4 cohort studies were included. The SR found that intensified patient care improved adherence and decreased levels of total serum cholesterol and low-density lipoprotein cholesterol (LDL-C) at 6 months or more of follow-up. Compared with statin treatment discontinuation, nondaily statin dosing lowered total cholesterol and LDL-C levels. One large cohort study suggested that more than 90% of patients who discontinued statin treatment could be rechallenged with the same or a different statin and be adherent 1 year after a statin-related adverse event led to discontinuation. Two small cohort studies reported that more than 90% of patients who were previously intolerant to statins and who had low baseline levels of vitamin D were able to adhere to statins 1 year after vitamin D supplementation.
LIMITATION: This is a qualitative synthesis of new evidence with existing meta-analyses, and studies had several methodological shortcomings.
CONCLUSION: Although the strength of evidence for most interventions was low or very low, intensified patient care and rechallenge with the same or a different statin (or a lower dose) seem to be favorable options for improving statin adherence.
PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.
PURPOSE: To assess the benefits and harms of interventions to improve statin adherence in patients at risk for CVD.
DATA SOURCES: MEDLINE, EMBASE, PubMed, and the Cochrane Library from December 2013 through May 2019 (English language only).
STUDY SELECTION: Systematic reviews (SRs), randomized controlled trials (RCTs), and cohort studies that addressed interventions for improving statin tolerance and adherence.
DATA EXTRACTION: One investigator abstracted data and assessed study quality, and a second investigator checked abstractions and assessments for accuracy.
DATA SYNTHESIS: One SR, 1 RCT, and 4 cohort studies were included. The SR found that intensified patient care improved adherence and decreased levels of total serum cholesterol and low-density lipoprotein cholesterol (LDL-C) at 6 months or more of follow-up. Compared with statin treatment discontinuation, nondaily statin dosing lowered total cholesterol and LDL-C levels. One large cohort study suggested that more than 90% of patients who discontinued statin treatment could be rechallenged with the same or a different statin and be adherent 1 year after a statin-related adverse event led to discontinuation. Two small cohort studies reported that more than 90% of patients who were previously intolerant to statins and who had low baseline levels of vitamin D were able to adhere to statins 1 year after vitamin D supplementation.
LIMITATION: This is a qualitative synthesis of new evidence with existing meta-analyses, and studies had several methodological shortcomings.
CONCLUSION: Although the strength of evidence for most interventions was low or very low, intensified patient care and rechallenge with the same or a different statin (or a lower dose) seem to be favorable options for improving statin adherence.
PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs.
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