Evidence map›Paper›PMID 29193523›Full record

Observational studyInternal medicine journal2018

Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study.

Rachel Hennein, Shih-Jen Hwang, Rhoda Au, Daniel Levy, Paul Muntner, Caroline S Fox, Jiantao Ma

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Internal medicine journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Article
  6. Article
  7. Article
  8. Review
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Rachel HenneinFramingham Heart Study, Framingham, Massachusetts, USA.ORCID 0000-0002-8266-6476
Shih-Jen HwangFramingham Heart Study, Framingham, Massachusetts, USA.
Rhoda AuDepartment of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.
Daniel LevyFramingham Heart Study, Framingham, Massachusetts, USA.
Paul MuntnerDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Caroline S FoxFramingham Heart Study, Framingham, Massachusetts, USA.
Jiantao MaFramingham Heart Study, Framingham, Massachusetts, USA.

Funding

Framingham Project/LevyZ01HL006001 · NHLBI · NATIONAL HEART, LUNG, AND BLOOD INSTITUTE · PI LEVY, DANIEL · 2008 to 2008
$1.1M
Intramural NIH HHS Z01 HL006001Intramural NIH HHS Z99 HL999999NHLBI NIH HHS HHSN268201500001I
6 · The paper itself

Abstract

backgroundIn the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD).

aimWe 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.

methodsThe 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.

resultsAmong 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.

conclusionsDepressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older-aged adults.

Indexed as

Self ReportAgedAntihypertensive AgentsCardiovascular DiseasesCohort StudiesCross-Sectional StudiesDepressionFemaleHumansHypoglycemic AgentsHypolipidemic AgentsMaleMedication AdherenceMiddle AgedRisk FactorsAntihypertensive AgentsHypoglycemic AgentsHypolipidemic Agentscardiovascular diseasescholesteroldiabetes mellitus, Type 2hypertensionmedication adherence

Identifiers

PMID29193523
PMCPMC5889324

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.