Academic Commons


Predictors of Nonadherence to Statins: A Systematic Review and Meta-Analysis

Mann, Devin M.; Woodard, Mark; Muntner, Paul; Falzon, Louise; Kronish, Ian M.

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 (I2 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.


  • thumnail for Mann_Ann_Pharmacother_2010_PMC.pdf Mann_Ann_Pharmacother_2010_PMC.pdf application/pdf 3.54 MB Download File

Also Published In

Annals of Pharmacotherapy

More About This Work

Academic Units
Center for Behavioral Cardiovascular Health
SAGE Publications
Published Here
May 14, 2016
Academic Commons provides global access to research and scholarship produced at Columbia University, Barnard College, Teachers College, Union Theological Seminary and Jewish Theological Seminary. Academic Commons is managed by the Columbia University Libraries.