title: Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities.
abstract: BACKGROUND
  Easily detectable predictors of nonadherence to long-term drug treatment are lacking. We investigated the association between lifestyle factors and nonadherence to statin therapy among patients with and without cardiovascular comorbidities.
  
  
  METHODS
  We included 9285 participants from the Finnish Public Sector Study who began statin therapy after completing the survey. We linked their survey data with data in national health registers. We used prescription dispensing data to determine participants' nonadherence to statin therapy during the first year of treatment (defined as < 80% of days covered by filled prescriptions). We used logistic regression to estimate the association of several lifestyle factors with nonadherence, after adjusting for sex, age and year of statin initiation.
  
  
  RESULTS
  Of the participants without cardiovascular comorbidities (n = 6458), 3171 (49.1%) were nonadherent with their statin therapy. Obesity (adjusted odds ratio [OR] 0.86, 95% confidence interval [CI] 0.74-0.99), overweight (adjusted OR 0.88, 95% CI 0.79-0.98) and former smoking (adjusted OR 0.82, 95% CI 0.74-0.92) predicted a reduced risk of nonadherence in this group after adjustment for sex, age and year of statin initiation. Of the participants with cardiovascular comorbidities (n = 2827), 1155 (40.9%) were nonadherent. In this group, high alcohol consumption (adjusted OR 1.55, 95% CI 1.12-2.15), extreme drinking occasions (adjusted OR 1.48, 95% CI 1.11-1.97) and a cluster of 3-4 lifestyle risks (adjusted OR 1.61, 95% CI 1.15-2.27) predicted increased odds of nonadherence after adjustment for sex, age and year of statin initiation.
  
  
  CONCLUSIONS
  People with cardiovascular comorbidities who had risky drinking behaviours or a cluster of lifestyle risks were at increased risk of nonadherence. Among individuals without cardiovascular comorbidities, information on lifestyle factors was unhelpful in identifying those at increased risk of nonadherence; that overweight, obesity and former smoking were predictors of better adherence in this group provides insight into mechanisms of adherence to preventive medication that deserve further study.
authors: Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK heli.halava@utu.fi.
authors: Heli
authors: H
authors: Halava
authors: Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK.
authors: Maarit Jaana
authors: MJ
authors: Korhonen
authors: Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK.
authors: Risto
authors: R
authors: Huupponen
authors: Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK.
authors: Soko
authors: S
authors: Setoguchi
authors: Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK.
authors: Jaana
authors: J
authors: Pentti
authors: Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK.
authors: Mika
authors: M
authors: Kivimäki
authors: Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK.
authors: Jussi
authors: J
authors: Vahtera
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D050171:Dyslipidemias / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D016903:Drug Monitoring
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors