Yow Deborah Keng Wai, Ang Wei Jie, Yap Hao Jeun, Ito Sakura, Liu Jintana, Ko Junsuk, Tan Doreen Su-Yin, Lorenzatti Alberto, Ang Chin-Siang
Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
EClinicalMedicine. 2025 May 26;84:103270. doi: 10.1016/j.eclinm.2025.103270. eCollection 2025 Jun.
Poor medication adherence to lipid-lowering medications (LLMs) remains a barrier in reducing the burden of cardiovascular disease (CVD). We sought to review interventions aimed at improving adherence to LLMs for the primary or secondary prevention of CVD, and evaluate their effectiveness on patient outcomes.
A systematic review and meta-analysis was performed according to PRISMA guidelines. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and CINAHL, were searched for studies published between January 1, 2016 and October 3, 2024, reporting randomised controlled trials on interventions to enhance adherence to LLMs. Cochrane's Risk-of-Bias (ROB-2) tool was utilised for quality appraisal. A narrative analysis and a random-effects meta-analysis was conducted, with adherence to LLMs as main outcomes. Pooled effects were calculated using Standardised Mean Difference (SMD) or Odds Ratios (OR). The review's protocol is available on Open Science Framework (https://osf.io/9gx5h).
The systematic review and meta-analysis included 35 and 15 studies, respectively. Participants (n = 51,824) had a mean age ranging 50.2-74.4 years. 6 distinct interventions were employed; most were conducted in primary care settings and employed intensified patient care. Overall, interventions assessed with continuous (SMD 0.17, 95% CI [0.04, 0.31]) and dichotomous (OR 1.26, 95% CI [1.08, 1.47]) measures showed improvements in adherence. Participants who engaged in complex behavioural approaches exhibited improved adherence in dichotomous (OR 1.74, 95% CI [1.17, 2.58]) and continuous outcomes (SMD 0.35, 95% CI [0.15, 0.54]). Pooled estimates suggest no differences in physiological outcomes between the groups. A risk-of-bias assessment following worst-case scenario analysis assessed 3 studies as "low risk", 11 as "high risk", and 21 as "unclear risk".
Current interventions bring about improvements in medication adherence, but such improvements are not sustained over the long-term. For real world and practice implications, interventions must be multipronged in nature, addressing a combination of at least two dimensions of medication adherence. Additional global studies, particularly long-term randomised controlled trials, are required to corroborate our findings.
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降脂药物（LLMs）的用药依从性差仍然是减轻心血管疾病（CVD）负担的一个障碍。我们试图回顾旨在改善LLMs依从性以进行CVD一级或二级预防的干预措施，并评估其对患者预后的有效性。
根据PRISMA指南进行系统评价和荟萃分析。检索Cochrane对照试验中心注册库、MEDLINE、EMBASE、PsycINFO和CINAHL，查找2016年1月1日至2024年10月3日期间发表的报告关于提高LLMs依从性干预措施的随机对照试验。采用Cochrane偏倚风险（ROB - 2）工具进行质量评估。进行叙述性分析和随机效应荟萃分析，以LLMs依从性作为主要结局。使用标准化均数差（SMD）或比值比（OR）计算合并效应。该综述的方案可在开放科学框架（https://osf.io/9gx5h）上获取。
系统评价和荟萃分析分别纳入35项和15项研究。参与者（n = 51,824）的平均年龄在50.2 - 74.4岁之间。采用了6种不同的干预措施；大多数在初级保健机构进行，并采用强化患者护理。总体而言，采用连续性（SMD 0.17，95% CI [0.04, 0.31]）和二分法（OR 1.26，95% CI [1.08, 1.47]）测量评估的干预措施显示依从性有所改善。采用复杂行为方法的参与者在二分法（OR 1.74，95% CI [1.17, 2.58]）和连续性结局（SMD 0.35，95% CI [0.15, 0.54]）方面表现出依从性改善。合并估计表明两组之间生理结局无差异。在最坏情况分析后的偏倚风险评估中，将3项研究评估为“低风险”，11项为“高风险”，21项为“风险不明”。
当前的干预措施可提高用药依从性，但这种改善在长期内无法持续。对于实际应用和实践意义而言，干预措施必须具有多方面性质，至少从用药依从性的两个维度进行综合考量。需要更多全球研究，尤其是长期随机对照试验，来证实我们的研究结果。
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