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Patient Prefer Adherence. 2018 Dec 18;13:9-19. doi: 10.2147/PPA.S182765. eCollection 2019.

Association of medication adherence and depression with the control of low-density lipoprotein cholesterol and blood pressure in patients at high cardiovascular risk.

Author information

1
Department of Cardiology, Universitätsklinikum Leipzig, Leipzig, Germany, julius.katzmann@medizin.uni-leipzig.de.
2
Medical Clinic III, Cardiology, Angiology, Intensive Care, Universitätsklinikum des Saarlandes, Homburg, Germany.
3
Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany.
4
Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.

Abstract

Background:

Many patients at high cardiovascular risk do not reach targets for low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP). Depression is a frequent comorbidity in these patients and contributes to poor medication adherence.

Objective:

The aim of this study was to elucidate the associations between adherence to lipid-and BP-lowering drugs, the diagnosis of depression, and the control of LDL-C and BP.

Patients and methods:

This study was conducted as multicenter, single-visit cross-sectional study in Germany. Adherence was assessed by the Morisky Medication Adherence Scale-8 (MMAS-8), and depression was assessed as documented in the patient chart.

Results:

A total of 3,188 ambulatory patients with hypercholesterolemia (39.8%), stable coronary artery disease (CAD; 7.4%), or both (52.9%) were included. Patients had a history of myocardial infarction (30.8%), diabetes (42.0%), were smokers (19.7%), and 16.1% had the investigator-reported diagnosis of depression. High or moderate adherence to lipid-lowering medication compared to low adherence was associated with lower LDL-C levels (105.5±38.3 vs 120.8±42.4 mg/dL) and lower BP (systolic BP 133.4±14.5 vs 137.9±13.9 mmHg, diastolic BP 78.3±9.6 vs 81.8±9.6 mmHg) and with a higher proportion of patients achieving the guideline-recommended LDL-C (16.9% vs 10.1%) and BP target (52.2% vs 40.8%, all comparisons P<0.0001). Adherence was worse in patients with depression. Correspondingly, patients with depression showed higher LDL-C levels, higher BP, and a lower probability of achieving the LDL-C and BP goal. Medication adherence correlated between BP- and lipid-lowering medications.

Conclusion:

Self-reported medication adherence can be easily obtained in daily practice. A low adherence and the diagnosis of depression identify patients at risk for uncontrolled LDL-C and BP who likely benefit from intensified care.

KEYWORDS:

LDL cholesterol; MMAS-8; adherence; blood pressure; cardiovascular disease; coronary artery disease; depression; lipids; prevention; statin

Conflict of interest statement

Disclosure Julius L Katzmann reports grants from Servier Deutschland GmbH, Germany, non-financial support from Pharmalog, Institut für klinische Forschung GmbH, Oskar-Messter-Straße 29, Ismaning, Germany, during the conduct of the study; Michael Böhm reports personal fees from Amgen, personal fees from Bayer, personal fees from Servier, personal fees from Medtronic, personal fees from Boehringer Ingelheim, nothing from Vifor, personal fees from Bristol Myers Squibb, outside the submitted work; and Ulrich Laufs report other from Servier, during the conduct of the study. The authors report no other conflicts of interest in this work.

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