Childhood adversity as a predictor of non-adherence to statin therapy in adulthood.

Maarit Jaana Korhonen,Ichiro Kawachi,Mika Kivimäki,Jussi Vahtera,Hasse Karlsson,Jaana Pentti,M Alan Brookhart,Jaana I Halonen

doi:10.1371/journal.pone.0127638

Abstract

PurposeTo investigate whether adverse experiences in childhood predict non-adherence to statin therapy in adulthood.MethodsA cohort of 1378 women and 538 men who initiated statin therapy during 2008–2010 after responding to a survey on childhood adversities, was followed for non-adherence during the first treatment year. Log-binomial regression was used to estimate predictors of non-adherence, defined as the proportion of days covered by dispensed statin tablets <80%. In fully adjusted models including age, education, marital status, current smoking, heavy alcohol use, physical inactivity, obesity, presence of depression and cardiovascular comorbidity, the number of women ranged from 1172 to 1299 and that of men from 473 to 516, because of missing data on specific adversities and covariates.ResultsTwo in three respondents reported at least one of the following six adversities in the family: divorce/separation of the parents, long-term financial difficulties, severe conflicts, frequent fear, severe illness, or alcohol problem of a family member. 51% of women and 44% of men were non-adherent. In men, the number of childhood adversities predicted an increased risk of non-adherence (risk ratio [RR] per adversity 1.11, 95% confidence interval [CI] 1.01–1.21], P for linear trend 0.013). Compared with those reporting no adversities, men reporting 3–6 adversities had a 1.44-fold risk of non-adherence (95% CI 1.12–1.85). Experiencing severe conflicts in the family (RR 1.27, 95% CI 1.03–1.57]) and frequent fear of a family member (RR 1.27, 95% CI 1.00–1.62]) in particular, predicted an increased risk of non-adherence. In women, neither the number of adversities nor any specific type of adversity predicted non-adherence.ConclusionsExposure to childhood adversity may predict non-adherence to preventive cardiovascular medication in men. Usefulness of information on childhood adversities in identification of adults at high risk of non-adherence deserves further research.

Highlights

Experiencing severe conflicts in the family (RR 1.27, 95% confidence intervals (CI) 1.03–1.57]) and frequent fear of a family member (RR 1.27, 95% CI 1.00–1.62]) in particular, predicted an increased risk of non
According to a recent meta-analysis [1], ~9% of cardiovascular events can be attributable to non-adherence to preventive cardiovascular medications
Childhood adversity has been associated with the emergence of cardiovascular risk factors, such as high systolic blood pressure [6], obesity [7], type 2 diabetes [7], binge drinking [8], and smoking [9, 10], and higher overall cardiometabolic risk in adulthood [11]

Summary

Introduction

According to a recent meta-analysis [1], ~9% of cardiovascular events can be attributable to non-adherence to preventive cardiovascular medications. Longitudinal studies suggest an increased risk of cardiovascular events among individuals reporting such childhood adversities as financial difficulties, interpersonal conflicts, long-term illness in the family [12], or physical abuse [13]. Childhood adversities are strongly linked with adulthood depression [14], another cardiovascular risk factor and a correlate of non-adherence [15, 16]. It seems plausible that the associations between childhood adversity and cardiovascular disease later in life may be partly mediated by medication non-adherence. One previous study, including men only, has investigated the association between childhood adversity and non-adherence to cardiovascular medication in adulthood: low socioeconomic position in childhood, operationalized as father’s occupation at birth, was found to predict discontinuation of statin therapy in middle age [17]

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