Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Margrét Leósdóttir, Lund University, Sweden
- Second opponent: Professor Olav Spigset, NTNU - Norwegian University of Science and Technology,
- Third member and chair of the evaluation committee: Professor Marit Bragelien Veierød, University of Oslo
Chair of the Defence
Professor Per Ole Iversen, University of Oslo
Principal Supervisor
Professor John Munkhaugen, University of Oslo
Summary
This thesis aimed to investigate long-term treatment patterns, adherence, and persistence to lipid lowering drugs among contemporary populations in Norway, both with and without established cardiovascular disease. We also aimed to investigate the associations between clinical characteristics and reduced adherence to treatment. The research consists of three registry studies based on data from the Norwegian Prescribed Drug Registry and explores adherence and persistence to traditional and novel lipid lowering therapies.
We found a significant underutilization of lipid lowering drugs in Norway across all studies, with a considerable proportion of patients with atherosclerotic cardiovascular disease and/or at high or very high risk remaining untreated across all studies. Adherence and persistence to statin therapy was low across all studies, which is particularly concerning in the high and very high-risk populations. The proportion with reduced adherence to statins was 31% among all users of lipid lowering drugs in Norway, while it was 22% among patients with established cardiovascular disease. Patients who initiate novel add-on treatment often discontinue statins, even though maximal benefit requires combination therapy.
Overall, we found it challenging to establish strong association between demographic and clinical patient characteristics and reduced adherence. However, smoking, and psychological distress appeared to correlate. We observed an association between self-perceived side effects of statins and reduced adherence. Further, patients with poor persistence to statins were more likely to exhibit similar patterns with other lipid lowering drugs. This may indicate that side-effects and non-adherent behavior are important barriers to adherence and persistence to lipid lowering drugs.
Additional information
Contact the research support staff.