Assessment of the Compliance of Statin Treatment in Hyperlipidemic Patients and its Association with Socioeconomic Status

Objectives: To assess the compliance of statin treatment in hyperlipidemic patients and its association with Socioeconomic Status in Nawabshah, Sindh, Pakistan. Original Research Article Irum et al.; JPRI, 34(41A): 57-63, 2022; Article no.JPRI.87735 58 Methodology: This was a retrospective cross-sectional study using convenient sampling technique conducted in collaboration with Department of Cardiology & Medicine People Medical College Hospital (PMCH) Nawabshah, Sindh, Pakistan during January to June 2015. A total of 100 patients suffering from Hyperlipidemia (diagnosed) were recruited from out patients department (OPD) of Cardiology & Medicine department. The data was collected by administering the questionnaire to Hyperlipidemic patients after a written consent. All the variables related to socioeconomically class on per designed questionnaire were registered by filling the designed Proforma. Results: Out of 100 patients enrolled the mean age of the patients was 49.45± 9.72 years. The mean cholesterol levels were 231.83± 15.9 mg/dl. Statin therapy compliance was compared with socioeconomic status. Statin therapy compliance was achieved in socio-economic status which revealed > 80% proportion of days covered (PDC) response however results statistical significance was P-value 0.056. Conclusion: Hyperlipidemic patients have shown a good compliance to statins. Compliance in both lower and middle class was more than in higher class.


INTRODUCTION
Patient's adherence with treatment can be strongly predicted through the stability amid requirements for medication & interests over their usage. The reason of the poor conformity and therapy for asymptomatic long-term condition like dyslipidemia is the demonstration of this opinion of the comparative benefits and risk of treatment. Patients could consequently have decreased compliance with long term management and may not distinguish any benefit of therapy, because there are no clear signs of dyslipidemia [1][2][3][4][5]. Patients treated for primary prevention have lesser acceptance to statin therapy than patients with clear sign of CHD like new ACS i-e; acute coronary syndrome due the better awareness of the need for treatment. Aware patients with increased CHD risk like diabetes or hypertension explain greater conformity rates with lipid lowering medication. The consequences of CHD usually occur with increasing age since it is associated with increasing age. Unaware patients of long term management stop taking their medication and may consider themselves cured on treatment is applied and cholesterol reduced to be suggested level. On other hand, this information may be taken out of context and information sources may not necessarily be precise. Patients' poor info decisions make them non-compliant. As a result, the contribution to the more compliant behavior is due to the more risk awareness of CHD and aids of treatment [6][7][8][9][10].
The aim of this study is to assess the compliance of statin treatment in hyperlipidemic patients and its association with Socioeconomic Status Nawabshah, Sindh, Pakistan.

METHODOLOGY
This was a retrospective cross-sectional study using convenient sampling technique conducted in collaboration with Department of Cardiology & Medicine People Medical College Hospital (PMCH) Nawabshah, Sindh, Pakistan during January to June 2015. A total of 100 patients suffering from Hyperlipidemia (diagnosed) were recruited from out patients department (OPD) of Cardiology & Medicine department. The data was collected by administering the questionnaire to Hyperlipidemic patients after a written consent. All the variables related to socioeconomically class on per designed questionnaire were registered by filling the designed Proforma.

Inclusion Criteria
The following patients were included in this study:

Data Analysis
After completion of the study, the data was computed. Finally, data was evaluated by using statistical software SPSS, IBM to check the significance of the results. Compliance to the statin related to socio economic class was calculated and appropriate test were applied in data analysis.

Fig. 5. Graphical presentation of Stain compliance association with socioeconomic status
The socioeconomic group was divided into three on the basis of monthly income i-e; lower class with monthly income of less than 10,000 rupees, middle class with monthly income between range of 10,000 to 50,000 rupees and higher class is considered those having above 50,000.
Both the groups the statin therapy compliance was compared with socioeconomic status. Statin therapy compliance was achieved in both age groups revealing no statistical significance after comparison of socioeconomic status with statin therapy, however all groups lower, middle and higher class have shown proportion of days covered (PDC) > 80% with slightly lower compliance seen in lower class probably due to non-affordability. (p value-0.056) ( Table 3).

DISCUSSION
The mortality is declining in patients with coronary heart diseases due to strategies involving risk reduction which has been achieved by statin use. The mortality benefits from Myocardial Infarction seen after statin therapy has also been reduced from 21% to 7%. Despite this usefulness, non-compliance is a significant risk that poses the individual to suffer from preventable cause. Compliance has been shown to be reduced in Chinese and Asians [12].
A study carried out by Qamaral-Haq, showed increased incidence among higher socioeconomic people of younger age are more affected. Also found increased compliance in patients with comorbidities like hypertension and dyslipidemia. He in his research conducted that 150 patients responded to diet and regular exercise and that restriction of diet reduced significantlylipids in hyperlipidemic patients [13].
In our study comparison between two groups like the patients with hyperlipidemia with socioeconomic status showed that no statistical significance was revealed after socioeconomic status with hyperlipidemia however little higher incidence was seen in middle aged individuals.
In our study both the groups i-e; the statin therapy compliance was compared with socioeconomic status. Statin therapy compliance no statistical significance was revealed after socioeconomic status with statin therapy, however all groups lower, middle and higher class have shown PDC > 80% with slightly lower compliance seen in lower class probably due to non-affordability.
Therefor it is necessary that patients whether symptomatic or having asymptomatic hyperlipidemias should have strict dietary control as well as strict compliance and adherence of antihyperlipidemic medications. Not only this but also the control of comorbidities like strict glycemic control in diabetes mellitus, hypertension, and all other modifiable factors like quit smoking or alcohol abuse, control of obesity by modifying lifestyles is important in order to achieve desired goal and help decrease morbidity and mortality due to complications of hyperlipidemia.

CONCLUSION
Hyperlipidemic patients have shown a good compliance to statins. Compliance in both lower and middle class was more than in higher class.

ETHICAL APPROVAL
This study was approved by ethical review committee of People's University of Medical and Health Sciences for Women Nawabshah, Sindh, Pakistan.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).