Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population-based study

Renata Cristina Rezende Macedo do Nascimento, Tanja Mueller*, Brian Godman, Sean MacBride Stewart, Simon Hurding, Francisco de Assis Acurcio, Augusto Afonso Guerra Junior, Juliana Alvares Teodoro, Alec Morton, Marion Bennie, Amanj Kurdi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Aim: To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. Method: Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scotland. Study outcomes comprised adherence, discontinuation and persistence to treatment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill-gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan-Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results: A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high-intensity patients less likely to discontinue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34-0.55]; no prior CVD: 0.80 [0.74-0.86]). Persistence declined over time, and high-intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adherence was considerably higher among high-intensity patients (63.7%). Conclusion: High-intensity statins were associated with better persistence and adherence to treatment, but overall long-term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.

Original languageEnglish
Pages (from-to)2349-2361
Number of pages13
JournalBritish Journal of Clinical Pharmacology
Issue number12
Publication statusPublished - Dec 2020


  • Scotland
  • cardiovascular disease
  • drug utilisation
  • high-intensity therapy
  • medication adherence
  • statins


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