Predictors of nonadherence to statins: a systematic review and meta-analysis

Ann Pharmacother. 2010 Sep;44(9):1410-21. doi: 10.1345/aph.1P150. Epub 2010 Aug 11.


Background: Nonadherence to statins limits the benefits of this common drug class. Individual studies assessing predictors of nonadherence have produced inconsistent results.

Objective: To identify reliable predictors of nonadherence to statins through systematic review and meta-analysis.

Methods: Multiple databases, including MEDLINE, EMBASE, and PsycINFO, were searched (from inception through February 2009) to identify studies that evaluated predictors of nonadherence to statins. Studies were selected using a priori defined criteria, and each study was reviewed by 2 authors who abstracted data on study characteristics and outcomes. Relative risks were then pooled, using an inverse-variance weighted random-effects model.

Results: Twenty-two cohort studies met inclusion criteria. Age had a U-shaped association with adherence; the oldest (>/=70 years) and youngest (<50 years) subjects had lower adherence than the middle-aged (50-69 years) subjects. Women and patients with lower incomes were more likely to be nonadherent than were men (odds of nonadherence 1.07; 95% CI 1.04 to 1.11) and those with higher incomes (odds of nonadherence 1.18; 95% CI 1.10 to 1.28), respectively. A history of cardiovascular disease predicted better adherence to statins (odds of nonadherence 0.68; 95% CI 0.66 to 0.78). Similarly, a diagnosis of hypertension or diabetes was associated with better adherence. Although there were too few studies for quantitative pooling, increased testing of lipid levels and lower out-of-pocket costs appeared to be associated with better adherence. There was substantial (I(2) range 68.7-96.3%) heterogeneity between studies across factors.

Conclusions: Several sociodemographic, medical, and health-care utilization characteristics are associated with statin nonadherence. These factors may be useful guides for targeting statin adherence interventions.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Age Factors
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / epidemiology*
  • Cohort Studies
  • Comorbidity
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / epidemiology*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypertension / drug therapy
  • Hypertension / epidemiology*
  • Patient Compliance / psychology*
  • Patient Compliance / statistics & numerical data
  • Socioeconomic Factors


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors