Sammendrag
Background and aims: We aimed to determine the relationship between statin adherence measured directly, and
by self-report measures and serum cholesterol levels.
Methods: Patients prescribed atorvastatin (N = 373) participated in a cross-sectional study 2–36 months after a
coronary event. Self-reported adherence included statin adherence the past week, the 8-item Morisky medication
adherence scale (MMAS-8), and the Gehi et al. adherence question. Atorvastatin was measured directly in spot
blood plasma by a novel liquid chromatography tandem mass-spectrometry method discriminating adherence
(0–1 doses omitted) and reduced adherence (≥2 doses omitted). Participants were unaware of the atorvastatin
analyses at study participation.
Results: Mean age was 63 (SD 9) years and 8% had reduced atorvastatin adherence according to the direct
method. In patients classified with reduced adherence by the direct method, 40% reported reduced statin
adherence, 32% reported reduced adherence with the MMAS-8 and 22% with the Gehi question. In those
adherent by the direct method, 96% also reported high statin adherence, 95% reported high adherence on the
MMAS-8 whereas 94% reported high adherence on the Gehi question. Cohen’s kappa agreement score with the
direct method was 0.4 for self-reported statin adherence, 0.3 for the Gehi question and 0.2 for the MMAS-8.
Adherence determined by the direct method, self-reported statin adherence last week, and the Gehi question
was inversely related to LDL-cholesterol levels with a p-value of
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