Advertisement

Visualizing coronary calcium is associated with improvements in adherence to statin therapy

      Abstract

      Background

      Many patients lack motivation to control cardiovascular risk factors and clinicians have long sought ways to activate apathetic patients. Despite significant and consistent data on the benefits of lipid-lowering agents to reduce cardiovascular events, adherence and utilization of these agents remains low. We evaluated whether visualization of coronary calcium would positively affect patients’ adherence rates.

      Methods

      We evaluated patients who underwent electron beam tomography (EBT) coronary calcium evaluation at least 1 year prior with a survey questioning them about health behaviors. Patients filled out baseline and follow-up questionnaires relating to lifestyle modifications, including statin utilization, diet, exercise, tobacco cessation and vitamin/antioxidant utilization.

      Results

      The study population consisted of 505 individuals on statin therapy on baseline who were followed for a mean of 3 ± 2 years. Overall the statin compliance was lowest (44%) among those with CAC score in the first quartile (0–30), whereas 91% of individuals with baseline CAC score in the fourth quartile (≥526) adhered to statin therapy. In multivariable analysis, after adjusting for cardiovascular risk factors, age, and gender, higher baseline CAC scores were strongly associated with adherence to statin therapy.

      Conclusions

      In addition to risk stratification for the asymptomatic person, patients visualizing coronary artery calcium may improve utilization and adherence to lipid-lowering therapy. Outcome studies and randomized trials need to be done to quantify the true value and cost-effectiveness of this approach.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Heart Protection Study Collaborative Group
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial.
        Lancet. 2002; 360: 7-22
        • Aranow H.D.
        • Topol E.J.
        • Roe M.T.
        • et al.
        Effect of lipid-lowering therapy on early mortality after acute coronary syndromes; an observational study.
        Lancet. 2001; 357: 1063-1068
        • Schwartz G.G.
        • Olsson A.G.
        • Ezekowitz M.D.
        • et al.
        Effect of lipid-lowering therapy on early mortality after acute coronary syndromes: an observational study.
        JAMA. 2001; 285: 1711-1718
        • Pearson T.A.
        • Laurora I.
        • Chu H.
        • et al.
        The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals.
        Arch Intern Med. 2000; 160: 459-467
        • Robertson I.
        • Phillips A.
        • Mant D.
        • et al.
        Motivational effect of cholesterol measurement in general practice health checks.
        Br J Gen Pract. 1992; 42: 469-472
        • Horwitz R.I.
        • Viscoli C.M.
        • Berkman L.
        • et al.
        Treatment adherence and risk of death after a myocardial infarction.
        Lancet. 1990; 336: 542-545
        • Aranow H.D.
        • Novaro G.M.
        • Lauer M.S.
        • et al.
        In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis.
        Arch Intern Med. 2003; 163: 2576-2582
      1. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.

        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • et al.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Frolkis J.P.
        • Pearce G.L.
        • Nambi V.
        • et al.
        Statins do not meet expectations for lowering low-density lipoprotein cholesterol levels when used in clinical practice.
        Am J Med. 2002; 113: 625-629
        • Ko D.T.
        • Mamdani M.
        • Alter D.A.
        Lipid-lowering therapy with statins in high-risk elderly patients.
        JAMA. 2004; 291: 1864-1870
        • Arad Y.
        • Spadaro L.
        • Goodman K.
        • et al.
        Prediction of coronary events with electron beam computed tomography.
        J Am Coll Cardiol. 2000; 36: 1253-1260
        • Kondos G.T.
        • Hoff J.A.
        • Sevrukov A.
        • et al.
        Coronary artery calcium and cardiac events electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5,635 initially asymptomatic low to intermediate risk adults.
        Circulation. 2003; 107: 2571-2576
        • Arad Y.
        • Goodman K.J.
        • Roth M.
        • Newstein D.
        • Guerci AD.
        Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events the St. Francis heart study.
        J Am Coll Cardiol. 2005; 46: 158-165
        • Shaw L.J.
        • Raggi P.
        • Schisterman E.
        • et al.
        Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality.
        Radiology. 2003; 28: 826-833
        • Greenland P.
        • LaBree L.
        • Azen S.P.
        • et al.
        Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals.
        JAMA. 2004; 291: 210-215
      2. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. NIH Publication No. 02-5215, September 2002.

        • Smith S.C.
        • Greenland P.
        • Grundy S.M.
        Prevention conference v: beyond secondary prevention: identifying the high-risk patient for primary prevention. Executive summary.
        Circulation. 2000; 101: 111-116
        • DiMatteo M.R.
        • DiNicola D.D.
        Achieving patient compliance.
        Pergamon Press, New York1982
        • Rosenstock I.M.
        The health belief model.
        in: Glanz K. Lewis F. Rimer B. Health behavior and health education: theory research, and practice. Jossey Bass, San Francisco1990: 39-62
        • Ellis J.J.
        • Erickson S.R.
        • Stevenson J.G.
        • et al.
        Suboptimal statin adherence and discontinuation in primary and secondary prevention populations.
        J Gen Intern Med. 2004; 19: 638-645
        • Miller N.H.
        • Hill M.
        • Kottke T.
        • Ockene I.S.
        The multilevel compliance challenge: recommendations for a call to action: a statement for healthcare professionals.
        Circulation. 1997; 95: 1085-1090
        • DiMatteo M.R.
        • DiNicola D.D.
        Achieving patient compliance.
        Pergamon Press, New York1982
        • Kiortsis D.N.
        • Giral P.
        Factors Associated with low adherence with lipid lowereing drugs in hyperlipidemic patients.
        J Clin Pharm Ther. 2000; 25: 445-451
        • Wong N.D.
        • Detrano R.C.
        • Diamond G.
        • et al.
        Does coronary artery screening by electron beam computed tomography motivate healthy lifestyle behavious.
        Am J Cardiol. 1996; 78: 1220-1223
        • O’Malley P.G.
        • Feuerstein I.M.
        • Taylor A.J.
        Impact of electron beam tomography, with or without case management, on motivation, behavioral change and cardiovascular risk profile. A randomized controlled trial.
        JAMA. 2003; 289: 2215-2223
        • Straka R.J.
        • Fish J.T.
        • Benson S.R.
        • Suh J.H.
        Patient self reporting of compliance does not correspond with electronic monitoring: an evaluation using isosorbide dinitrate as a model drug.
        Pharmacotherapy. 1997; 17: 126-132
        • Liu H.
        • Golin C.E.
        • Miller L.G.
        • et al.
        A comparison study of multiple measures of adherence to HIV protease inhibitors.
        Ann Intern Med. 2001; 134: 968-977
      3. Miller LG, Hays RD. Measuring adherence to antiretroviral medications in clinical trials HIV Clin Trials 2000;1(1):36–46.

        • Greenland P.
        Improving risk of coronary heart disease. Can a picture make a difference.
        JAMA. 2003; 289: 2270-2272
        • Nasir K.
        • Budoff M.J.
        • Post W.S.
        • et al.
        Electron beam CT vs helical CT scans of coronary arteries: current utility and future directions.
        Am Heart J. 2003; 146: 949-977