title: Evaluation of the Effectiveness of a Patient-Centered Educational Mailer Designed to Improve Statin Adherence: A Pragmatic Trial.
abstract: BACKGROUND
  Patients with high total cholesterol have increased risk of cardiovascular disease. National Cholesterol Education Program (NCEP) and American Heart Association (AHA) guidelines recommend cholesterol lowering with statin medications; however, statin adherence remains poor. We hypothesized that patient-centered education on the 10-year risk for each of the major constituents of cardiovascular disease would increase statin adherence and achievement of the low-density lipoprotein cholesterol (LDL-C) goal.
  
  
  METHODS
  Veterans within the Salt Lake City Veterans Affairs (VA) Medical Center initiating statin therapy from October 2008 to December 2011 were randomized in a pragmatic design to receive either an educational mailer or usual care. The mailer outlined their 10-year global cardiovascular risk, separated into coronary heart disease, stroke, and congestive heart failure. The study was unblinded and followed an intention-to-treat analysis where outcome measures were obtained during normal care process. The primary outcome measure was the achievement of the LDL-C goal during the 12-month follow-up.
  
  
  RESULTS
  Two hundred and seven patients were randomly assigned to either the intervention arm (95) or the control arm (112). No differences in the proportion of patients meeting the LDL-C goal were detected during 12-months [Relative Risk (RR): 0.95 (95 percent confidence interval (CI): 0.77-1.17)] or 18-months [RR: 1.03 (95 percent CI: 0.84, 1.25)]. Patients in the intervention arm had higher adherence on average, e.g., intervention patients were more likely to have 70 percent or more days of statin therapy compared to patients who received standard care-though this did not reach statistical significance-RR: 1.33 (95 percent CI: 1.00, 1.78). There were no statistical differences in cardiovascular outcomes or mortality.
  
  
  CONCLUSIONS
  Patient education mailers sent to patients starting statin treatment did not have a clear impact on LDL-C goal achievement or adherence to statin therapy.
authors.affiliation: University of Utah, Department of Internal Medicine; Salt Lake City Veterans Affairs Medical Center.
authors.forename: John W
authors.initials: JW
authors.lastname: Nord
authors.affiliation: University of Utah, Department of Internal Medicine; Salt Lake City Veterans Affairs Medical Center.
authors.forename: Alalia
authors.initials: A
authors.lastname: Berry
authors.affiliation: University of Utah, Department of Internal Medicine; Salt Lake City Veterans Affairs Medical Center.
authors.forename: Barry
authors.initials: B
authors.lastname: Stults
authors.affiliation: University of Utah, Department of Internal Medicine; Salt Lake City Veterans Affairs Medical Center.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Burningham
authors.affiliation: University of Utah, Department of Internal Medicine.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
keywords: Cardiovascular Diseases; Hydroxymethylglutaryl-COA Reductase Inhibitors; Medication Adherence; Pragmatic trial