Rachel Hennein1,2, Shih-Jen Hwang1,2, Rhoda Au3,4,5, Daniel Levy1,2, Paul Muntner6, Caroline S Fox1,2,7, Jiantao Ma1,2. 1. Framingham Heart Study, Framingham, Massachusetts, USA. 2. Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA. 3. Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA. 4. Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA. 5. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA. 6. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. 7. Department of Genetics and Pharmacogenomics, Merck Research Labs, Boston, Massachusetts, USA.
Abstract
BACKGROUND: In the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD). AIM: We examined risk factors for medication adherence and the relationship between adherence and levels of CVD risk factors among older participants with hypertension, dyslipidaemia and diabetes in the Framingham Heart Study. METHODS: The four-item Morisky Medication Adherence Scale was administered to 1559 participants, median age 70 years, 53% women. We created an adherence score, ranging from 0 to 4, with low adherence defined as a score ≥2. CVD risk factors were assessed using standard protocols. Cognition was measured using the Mini-Mental State Examination (MMSE) and depressive symptoms were measured using the Center for Epidemiologic Studies of Depression (CES-D) scale. RESULTS: Among participants who self-reported taking antihypertensive, lipid-lowering and/or hyperglycaemic medication(s), 12% (n = 191) had low medication adherence. The risk of low adherence increased by 45% (95% confidence interval (CI): 25-68%, P < 0.001) per five-unit increase in CES-D score. In participants taking antihypertensive medication (n = 1017), low adherence was associated with higher mean diastolic blood pressure (73 mmHg, 95% CI: 71-75 vs 71 mmHg, 95% CI: 70-71; P = 0.04) after adjusting for covariates. Among participants taking lipid-lowering medication (n = 937), low adherence was associated with higher mean low-density lipoprotein cholesterol (92 mg/dL, 95% CI: 87-96 vs 86 mg/dL, 95% CI: 84-88; P = 0.03). Low adherence was not associated with fasting plasma glucose (P = 0.10) or haemoglobin A1c (P = 0.68) in the subgroup of participants (n = 192) taking hypoglycaemic medication. CONCLUSIONS: Depressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older-aged adults.
BACKGROUND: In the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD). AIM: We examined risk factors for medication adherence and the relationship between adherence and levels of CVD risk factors among older participants with hypertension, dyslipidaemia and diabetes in the Framingham Heart Study. METHODS: The four-item Morisky Medication Adherence Scale was administered to 1559 participants, median age 70 years, 53% women. We created an adherence score, ranging from 0 to 4, with low adherence defined as a score ≥2. CVD risk factors were assessed using standard protocols. Cognition was measured using the Mini-Mental State Examination (MMSE) and depressive symptoms were measured using the Center for Epidemiologic Studies of Depression (CES-D) scale. RESULTS: Among participants who self-reported taking antihypertensive, lipid-lowering and/or hyperglycaemic medication(s), 12% (n = 191) had low medication adherence. The risk of low adherence increased by 45% (95% confidence interval (CI): 25-68%, P < 0.001) per five-unit increase in CES-D score. In participants taking antihypertensive medication (n = 1017), low adherence was associated with higher mean diastolic blood pressure (73 mmHg, 95% CI: 71-75 vs 71 mmHg, 95% CI: 70-71; P = 0.04) after adjusting for covariates. Among participants taking lipid-lowering medication (n = 937), low adherence was associated with higher mean low-density lipoprotein cholesterol (92 mg/dL, 95% CI: 87-96 vs 86 mg/dL, 95% CI: 84-88; P = 0.03). Low adherence was not associated with fasting plasma glucose (P = 0.10) or haemoglobin A1c (P = 0.68) in the subgroup of participants (n = 192) taking hypoglycaemic medication. CONCLUSIONS:Depressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older-aged adults.
Authors: Marie Krousel-Wood; Tareq Islam; Paul Muntner; Elizabeth Holt; Cara Joyce; Donald E Morisky; Larry S Webber; Edward D Frohlich Journal: Ann Behav Med Date: 2010-12
Authors: Suma Vupputuri; Peter J Joski; Ryan Kilpatrick; J Michael Woolley; Brandi E Robinson; Michael E Farkouh; Huifeng Yun; Monika M Safford; Paul Muntner Journal: Am J Manag Care Date: 2016-03-01 Impact factor: 2.229
Authors: Marie A Krousel-Wood; Paul Muntner; Tareq Islam; Donald E Morisky; Larry S Webber Journal: Med Clin North Am Date: 2009-05 Impact factor: 5.456
Authors: Lia Gentil; Helen Maria Vasiliadis; Michel Préville; Cindy Bossé; Djamal Berbiche Journal: J Am Geriatr Soc Date: 2012-10-30 Impact factor: 5.562
Authors: Dhayana Dallmeier; Martin G Larson; Na Wang; João D Fontes; Emelia J Benjamin; Caroline S Fox Journal: J Am Heart Assoc Date: 2012-08-24 Impact factor: 5.501
Authors: Carmen Valdés Y Llorca; Ernesto Cortés Castell; José Manuel Ribera Casado; Pilar de Lucas Ramos; José Luis Casteig Ayestarán; Amaia Casteig Blanco; Vicente Francisco Gil Guillén; Mercedes Rizo Baeza Journal: Int J Environ Res Public Health Date: 2021-04-19 Impact factor: 3.390
Authors: Andrea Torres-Robles; Shalom I Benrimoj; Miguel Angel Gastelurrutia; Fernando Martinez-Martinez; Tamara Peiro; Beatriz Perez-Escamilla; Kris Rogers; Isabel Valverde-Merino; Raquel Varas-Doval; Victoria Garcia-Cardenas Journal: BMJ Qual Saf Date: 2021-03-29 Impact factor: 7.035