Adherence to Preferable Behavior for Lipid Control by High-Risk Dyslipidemic Japanese Patients Under Pravastatin Treatment: the APPROACH-J Study

Abstract

Aim: We evaluated the impact of adherence to preferable behavior on serum lipid control assessed by a self-reported questionnaire in high-risk patients taking pravastatin for primary prevention of coronary artery disease.
Methods: High-risk patients taking pravastatin were followed for 2 years. Questionnaire surveys comprising 21 questions, including 18 questions concerning awareness of health, and current status of diet, exercise, and drug therapy, were conducted at baseline and after 1 year. Potential domains were established by factor analysis from the results of questionnaires, and adherence scores were calculated in each domain. The relationship between adherence scores and lipid values during the 1-year treatment period was analyzed by each domain using multiple regression analysis.
Results: A total of 5,792 patients taking pravastatin were included in the analysis. Multiple regression analysis showed a significant correlation in terms of “Intake of high fat/cholesterol/sugar foods” (regression coefficient −0.58, p=0.0105) and “Adherence to instructions for drug therapy” (regression coefficient −6.61, p<0.0001). Low-density lipoprotein cholesterol (LDL-C) values were significantly lower in patients who had an increase in the adherence score in the “Awareness of health” domain compared with those with a decreased score. There was a significant correlation between high-density lipoprotein (HDL-C) values and “Awareness of health” (regression coefficient 0.26; p= 0.0037), “Preferable dietary behaviors” (regression coefficient 0.75; p<0.0001), and “Exercise” (regression coefficient 0.73; p= 0.0002). Similar relations were seen with triglycerides.
Conclusion: In patients who have a high awareness of their health, a positive attitude toward lipid-lowering treatment including diet, exercise, and high adherence to drug therapy, is related with favorable overall lipid control even in patients under treatment with pravastatin.