Thorsten Schier <[email hidden]> wrote in message news:<[email hidden]>...
Quoted message said:Bill schrieb:
Quoted message said:
"Nigel" <[email hidden]> wrote in message
"]news:[email hidden]...
Quoted message said:Quoted message said:Quoted message said::"]news:[email hidden]:
> I thought this article on statin compliance might be interesting.
>
> Bill
> _____________________________________
>
>
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> 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.
Quoted message said:Quoted message said:Quoted message said:
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.
Quoted message said:Quoted message said: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.
Quoted message said:Here is the text of thy study:
www.pjonline.com/pdf/papers/pj_20040110_compliance.pdf
Thanks for the link, Thorsten.
Quoted message said: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).
Quoted message said: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.
Quoted message said: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.
Quoted message said: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.
Quoted message said: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%.
Quoted message said: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
heartmdphd.comheartmdphd.comOpen ↗
