Clinical importance of adherence to treatment with eicosapentaenoic acid by patients with hypercholesterolemia.
BACKGROUND
Despite the risk of critical heart disease, poor adherence to treatment is common in patients with lifestyle-related diseases such as hypercholesterolemia. The association between adherence to treatment and clinical outcome was examined in JELIS (Japan EPA Lipid Intervention Study) and strategies for avoiding poor adherence were explored.


RESULTS
Patients taking 80% or more of the study medications were considered to exhibit good adherence. The primary endpoint was either sudden cardiac death or myocardial infarction. Adherence was lower in the eicosapentaenoic acid (EPA) + statin group (66.5%) than in the statin alone group (72.5%). In good adherers with previous coronary artery disease, EPA substantially reduced the risk compared with statin alone (hazard ratio 0.55, 95% confidence intervals 0.34-0.88, P<0.014). Furthermore, the clinical benefit of EPA + statin was significantly larger in patients with good adherence than in those with poor adherence (P=0.041). Finally, a 5-year risk prediction model constructed from the data indicated that complete adherence would lead to 51% reduction of risk compared with non-adherence.


CONCLUSIONS
Good adherence to medication was associated with a lower cardiovascular risk than with poor adherence, and the assistance of a pharmacist is of great importance in achieving persistent adherence during treatment.
Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine, Japan. horigasa@las.u-toyama.ac.jp
Hideki
H
Origasa
Mitsuhiro
M
Yokoyama
Masunori
M
Matsuzaki
Yasushi
Y
Saito
Yuji
Y
Matsuzawa
D000368:Aged; D000446:Aldehyde-Lyases / Q000097:blood; D003324:Coronary Artery Disease / Q000401:mortality / Q000517:prevention & control; D003577:Cytochrome P-450 Enzyme System / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000401:mortality*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D010595:Pharmacists; D011237:Predictive Value of Tests; D012307:Risk Factors; D016903:Drug Monitoring
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003577:Cytochrome P-450 Enzyme System; D015118:Eicosapentaenoic Acid; D000446:Aldehyde-Lyases; C054540:hydroperoxide lyase