title: Childhood adversity as a predictor of non-adherence to statin therapy in adulthood.
abstract: OBJECTIVE
  To investigate whether adverse experiences in childhood predict non-adherence to statin therapy in adulthood.
  
  
  METHODS
  A cohort of 1378 women and 538 men who initiated statin therapy during 2008-2010 after responding to a survey on childhood adversities, was followed for non-adherence during the first treatment year. Log-binomial regression was used to estimate predictors of non-adherence, defined as the proportion of days covered by dispensed statin tablets <80%. In fully adjusted models including age, education, marital status, current smoking, heavy alcohol use, physical inactivity, obesity, presence of depression and cardiovascular comorbidity, the number of women ranged from 1172 to 1299 and that of men from 473 to 516, because of missing data on specific adversities and covariates.
  
  
  RESULTS
  Two in three respondents reported at least one of the following six adversities in the family: divorce/separation of the parents, long-term financial difficulties, severe conflicts, frequent fear, severe illness, or alcohol problem of a family member. 51% of women and 44% of men were non-adherent. In men, the number of childhood adversities predicted an increased risk of non-adherence (risk ratio [RR] per adversity 1.11, 95% confidence interval [CI] 1.01-1.21], P for linear trend 0.013). Compared with those reporting no adversities, men reporting 3-6 adversities had a 1.44-fold risk of non-adherence (95% CI 1.12-1.85). Experiencing severe conflicts in the family (RR 1.27, 95% CI 1.03-1.57]) and frequent fear of a family member (RR 1.27, 95% CI 1.00-1.62]) in particular, predicted an increased risk of non-adherence. In women, neither the number of adversities nor any specific type of adversity predicted non-adherence.
  
  
  CONCLUSIONS
  Exposure to childhood adversity may predict non-adherence to preventive cardiovascular medication in men. Usefulness of information on childhood adversities in identification of adults at high risk of non-adherence deserves further research.
authors.affiliation: Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Public Health, University of Turku, Turku, Finland.
authors.forename: Maarit Jaana
authors.initials: MJ
authors.lastname: Korhonen
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Jaana I
authors.initials: JI
authors.lastname: Halonen
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Finnish Institute of Occupational Health, Turku, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.affiliation: Department of Clinical Science, University of Turku, Turku, Finland.
authors.forename: Hasse
authors.initials: H
authors.lastname: Karlsson
authors.affiliation: Department of Epidemiology and Public Health, University College of London, London, United Kingdom.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D000368:Aged; D005190:Family; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008016:Life Change Events; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors