***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Failure to adhere to medication regimes is a significant problem in clinical and research setting s yet reliable , consistent identification of key psychosocial predictors remains elusive . Studies of mood and personality related to adherence show mixed results —compliance and objective ly measured cognitive function are intuitively related but empirical support is lacking . Purpose : This study is a secondary analysis to examine the relations between adherence with a medication regime for lowering serum cholesterol and several domains of psychological and cognitive functioning . Methods : Participants in the initial study completed a measure of personality and a battery of neuropsychological measures  at baseline ; anxiety and depression  were measured at baseline and at 4-week intervals .  Medication adherence was tracked with electronic cap monitors for 24 weeks . Results : Only 23 % of the sample was fully adherent to medication regimes at least 80 % of the time over the 6-month study period . Conscientiousness , according to the Five Factor Theory of Personality , and estimated IQ remained robust predictors of adherence in hierarchical regression analyses . Depression and anxiety , mental flexibility , and visuospatial-constructional ability were less robust but statistically significant ( p < .05 ) correlates of adherence . Conclusions : Although results of this analysis explain only a portion of the variance in adherence , they demonstrate the importance of trait psychological and cognitive factors in adherence research Background Retirement has been suggested to reduce medication adherence , but no evidence is available for statins . We investigated changes in adherence to  statins  among Swedish adults after retirement . Methods A prospect i ve cohort study was carried out on all individuals living in Sweden on 31 December 2004 , alive in 2010 , having purchased statins in the second half of 2005 , and retired in 2008 ( n=11 718 ) . We used prescription dispensing data in 2006–2010 to determine nonadherence ( defined as < 80 % of days covered by filled prescriptions ) before and after old-age or disability retirement . Using multiple repeat measurements of filled statin prescriptions , we calculated the annual prevalence rates of nonadherence for those who continued therapy . Discontinuation was defined as no statin dispensations during a calendar year . Results After adjustment for age at retirement , the prevalence ratio ( PR ) of nonadherence after retirement in comparison with those before retirement was 1.23 [ 95 % confidence interval ( CI ) 1.17–1.29 ] for the men and 1.19 ( 95 % CI 1.13–1.26 ) for the women . A post-retirement increase in nonadherence was consistently observed across the strata of age at retirement , marital status , education , income , type of retirement , and participants with and without cardiovascular disease , the largest increases being observed for statin use in secondary prevention ( men : PR 1.38 , 95 % CI 1.26–1.54 ; women : PR 1.43 , 1.18–1.72 ) . For primary prevention , the corresponding prevalence ratios were 1.18 ( 95 % CI 1.13‒1.25 ) and 1.18 ( 95 % CI 1.11–1.24 ) , respectively . Interpretation Retirement appears to be associated with increased nonadherence to statin therapy among Swedish men and women BACKGROUND The objective of this study was to examine the association of Joint National Committee ( JNC-V ) blood pressure and National Cholesterol Education Program ( NCEP ) cholesterol categories with coronary heart disease ( CHD ) risk , to incorporate them into coronary prediction algorithms , and to compare the discrimination properties of this approach with other noncategorical prediction functions . METHODS AND RESULTS This work was design ed as a prospect i ve , single-center study in the setting of a community-based cohort . The patients were 2489 men and 2856 women 30 to 74 years old at baseline with 12 years of follow-up . During the 12 years of follow-up , a total of 383 men and 227 women developed  CHD , which was significantly associated with categories of blood pressure , total cholesterol , LDL cholesterol , and HDL cholesterol ( all P<.001 ) . Sex-specific prediction equations were formulated to predict CHD risk according to age , diabetes , smoking , JNC-V blood pressure categories , and NCEP total cholesterol and LDL cholesterol categories . The accuracy of this categorical approach was found to be comparable to CHD prediction when the continuous variables themselves were used . After adjustment for other factors , approximately 28 % of CHD events in men and 29 % in women were attributable to blood pressure levels that exceeded high normal ( > or = 130/85 ) . The corresponding multivariable-adjusted attributable risk percent associated with elevated total cholesterol ( > or = 200 mg/dL ) was 27 % in men and 34 % in women . CONCLUSIONS Recommended guidelines of blood pressure , total cholesterol , and LDL cholesterol effectively predict CHD risk in a middle-aged white population sample . A simple coronary disease prediction algorithm was developed using categorical variables , which allows physicians to predict multivariate CHD risk in patients without overt CHD Background —Little is known about the impact of hospitalization for an acute myocardial infa rct ion ( AMI ) on subsequent adherence to statins . Methods and Results —Using administrative cl aims from a 5 % r and om sample of Medicare beneficiaries , we identified a cohort of Medicare patients aged ≥65 years , hospitalized from 2007 to 2011 , taking statins in the year before AMI hospitalization ( n=6618 ) . We then determined the proportion of patients nonadherent to statins ( proportion of days covered < 80 % ) in the year before AMI hospitalization who became statin adherent ( proportion of days covered ≥80 % ) in the year after AMI hospitalization . The proportion of statin-adherent patients who became nonadherent was also studied . These proportions were compared with patients hospitalized for pneumonia ( n=11 471 ) and patients not hospitalized ( n=158 099 ) in 2010 and 2011 . Among patients nonadherent to statins before AMI hospitalization , 37.7 % became adherent after discharge . Patients hospitalized for AMI were more likely to become adherent than patients hospitalized for pneumonia ( adjusted relative risk : 1.70 ; 95 % confidence interval , 1.57–1.84 ) or patients not hospitalized ( adjusted relative risk : 1.79 ; 95 % confidence interval , 1.68–1.90 ) . Among patients adherent to statins before AMI hospitalization , 32.6 % became nonadherent after discharge . Those hospitalized for AMI were less likely to become nonadherent than those hospitalized for pneumonia ( adjusted relative risk : 0.93 ; 95 % confidence interval 0.88–0.98 ) but more likely to become nonadherent than patients without hospitalizations ( adjusted relative risk : 1.41 ; 95 % confidence interval , 1.35–1.48 ) . Conclusions —Among nonadherent patients , hospitalization for AMI was associated with increased likelihood of becoming adherent to statins compared with hospitalization for pneumonia or no hospitalizations . Among adherent patients , hospitalization for AMI was associated with increased likelihood of becoming nonadherent to statins compared with no hospitalizations Background : Despite the importance of patients ’ adherence to their drug treatments for achieving desired therapeutic goals and the proven role 3-hydroxy-3-methylglutaryl coenzyme A inhibitors ( statins ) for the health status of patients with cardiovascular diseases , there is not enough information regarding diabetic patients ’ adherence to statin therapy in developing countries . In this clinical study we aim ed to assess the adherence of diabetes type 2 patients to statin therapy in a research based community clinic in Iran . Material s and Methods : In this prospect i ve clinical study which was done at Isfahan Endocrinology and Metabolism Research Center , 204 diabetic type 2 patients under treatment with statin  were interviewed twice and their demographic data ( age , gender , body mass index , education ) , statin information ( type , dose ) and their serum lipid profile were recorded . Three months after the initial visits , patients were assessed using pill counting method and according to patients ’ self-reporting and also assessed low-density lipoprotein ( LDL ) cholesterol goal attainment < 100 mg/dl . Results : Adherence rate was 79.7 % and 69 % according to pill counting and self-reporting among study population . Moreover , 68.4 % of patients achieved their LDL cholesterol goal of < 100 mg/dl and adherent patients reached therapeutic goal significantly more than those who were considered non-adherence to statin therapy ( P < 0.01 ) . Conclusion : Adherence to statin therapy , as reflected by pill count method , is significantly related to LDL cholesterol goal achievement in patients with diabetes and dyslipidemia . Pill count method can be used to identify patients who are nonadherent to statin therapy and at high risk for failure to attain LDL cholesterol goals Background The purpose of this study was to evaluate the effectiveness of a patient education program developed to facilitate statin adherence . Methods A controlled trial was design ed to test the effectiveness of a multifaceted patient education program to facilitate statin adherence . The program included a brief , in-office physician counseling kit followed by patient mailings . The primary end point was adherence to filling statin prescriptions during a 120-day period . Patients new to statins enrolled and completed a survey . Data from a national pharmacy cl aims data base were used to track adherence . Results Patients new to statin therapy exposed to a patient counseling and education program achieved a 12.4 higher average number of statin prescription fill days and were 10 % more likely to fill prescriptions for at least 120 days ( p = .01 ) . Conclusion Brief in-office counseling on cardiovascular risk followed by patient education mailings can be effective in increasing adherence . Physicians found a one-minute counseling tool and pocket guidelines useful in counseling patients Background : Lipid-lowering treatment with statins has proven to be effective in reducing cardiovascular events and mortality . In daily practice , however , adherence to medication is often low and this compromises the therapeutic effect . The aim of this study was to assess the effectiveness of an electronic reminder device ( ERD ) with or without counseling to improve refill adherence and persistence for statin treatment in non-adherent patients . Methods : A multicenter , community pharmacy-based , r and omized controlled trial was conducted in 24 pharmacies in the Netherl and s among patients with pre-baseline refill adherence rates between 50 and 80 % . Eligible patients aged 65 years or older were r and omly assigned to 1 of 3 groups : ( 1 ) counseling with an ERD ( n = 134 ) , ( 2 ) ERD with a written instruction ( n = 131 ) , and a ( 3 ) control group that received the usual treatment ( n = 134 ) . Main outcome measure : refill adherence to statin treatment for a 360-day period after inclusion ( PDC360 ) . Patients with a refill rate ≥80 % were considered adherent . The effect among subgroups was also assessed . Results : There were no relevant differences at baseline . In the counseling with ERD group 54 of 130 eligible patients received the counseling with ERD . In the ERD group , 117 of 123 eligible patients received the ERD . The proportions of adherent patients in the counseling with ERD-group ( 69.2 % ) and in the ERD group ( 72.4 % ) were not higher than in the control group ( 64.8 % ) . Among women using statins for secondary prevention , more patients were adherent in the ERD group ( 86.1 % ) than in the control group ( 52.6 % ) ( p < 0.005 ) . In men using statins for secondary prevention the ERD was found to have no effect . Conclusion : In this r and omized controlled trial , no statistically significant improvement of refill adherence was found if an ERD was used with or without counseling . However , in a subgroup of women using statins for secondary prevention  the ERD did improve adherence significantly BACKGROUND Adherence to statins in real-world practice setting s is known to be suboptimal . However , less is known about how adherence changes over time and whether changes in adherence are associated with adverse cardiovascular ( CV ) outcomes . OBJECTIVES To ( a ) characterize yearly changes in adherence among initially adherent patients taking statins for primary prevention and ( b ) assess the association between changes in statin adherence with subsequent risk of CV events . METHODS A 10 % r and om sample of the IMS LifeLink Health Plan Cl aims Data base covering the time period from July 1 , 1997 , to December 31 , 2008 , was used to identify a cohort of primary prevention statin users .  Adherence was estimated in yearly segments beginning with the index statin prescription using proportion of days covered ( PDC ) . PDC was categorized into 3 levels : PDC ≥ 0.80 , 0.20 ≤ PDC < 0.80 , PDC < 0.20 . Patients were excluded if they experienced CV events or had PDC < 0.80 in their first year of statin exposure . Descriptive statistics were used to explore proportions of the cohort in each PDC category during each year . Cox-proportional ha 
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Income associated with adherence more strongly in men than women , and highly educated men were more likely and highly educated women less likely to be adherent .
Alcohol misuse and high BMI associated with non-adherence .
There was no association between polypharmacy and statin adherence .
Current evidence suggests that patients with more traditional risk factors for CVD are more likely to be adherent to  statins .