title: Assessing the adherence to and the therapeutic effectiveness of hypolipidemic agents in a population of patients in Brazil: a retrospective cohort study.
abstract: OBJECTIVE
  to evaluate the relation between patient adherence and therapeutic effectiveness of hypolipidemic agents in clinical practice.
  
  
  METHODS
  A retrospective cohort study of 417 patients using hypolipidemic drugs (simvastatin, atorvastatin) between 2003 and 2010 was performed. The population studied consists of patients assisted by the Public Health Service in the far-west region of the State of Santa Catarina, Brazil. The Medication Possession Ratio obtained from pharmacy refill data was used to measure patient adherence. Therapeutic effectiveness was evaluated based on the difference obtained in the serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, before and after taking the drug, in an average time of 8.3 months.
  
  
  RESULTS
  Following the treatment with hypolipidemic agents, it has been observed a reduction of 14.3% for total cholesterol, 19.6% for LDL-cholesterol, and 14.4% for triglycerides. HDL-cholesterol increased by an 8.0% average. The major changes in lipid profile were promoted by atorvastatin 20 mg daily. The medication adherence rate decreased over the monitoring period. Adherence rates below 60% were associated with therapeutic failure, while rates equal to 80% or higher were associated with the best response to the lipid-lowering drugs.
  
  
  CONCLUSIONS
  Adherence to hypolipidemic agents is higher at the beginning of the treatment, but it decreases over time, affecting the achievement of therapeutic goals.
authors.affiliation: Municipal Health of the São Miguel do Oeste and State Health Administration of the State of Santa Catarina. Florianópolis ( Brazil ).
authors.forename: Cássia
authors.initials: C
authors.lastname: Cunico
authors.affiliation: Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil ).
authors.forename: Geraldo
authors.initials: G
authors.lastname: Picheth
authors.affiliation: Department of Pharmacy, Federal University of Parana (UFPR) Curitiba, PR ( Brazil ).
authors.forename: Cassyano J
authors.initials: CJ
authors.lastname: Correr
authors.affiliation: Department of Medical Pathology, Federal University of Parana (UFPR) , Curitiba, PR ( Brazil ).
authors.forename: Marileia
authors.initials: M
authors.lastname: Scartezini
keywords: Brazil; Hypolipidemic Agents; Medication Adherence; Outcome and Process Assessment (Health Care); Primary Health Care