Published date: Dec 27 2024

Journal Title: Dubai Medical Journal

Issue title: Dubai Medical Journal (DMJ): Volume 7 Issue 4

Pages: 231 - 243

DOI: 10.18502/dmj.v7i4.17801

Hajra H. AmoodiInstitute of Public Health, United Arab Emirates University, Al Ain, Abu Dhabi

Luai A. AhmedInstitute of Public Health, United Arab Emirates University, Al Ain, Abu Dhabi

Javaid NaumanInstitute of Public Health, United Arab Emirates University, Al Ain, Abu Dhabi

Azhar T. Rahmaazhar.talal@uaeu.ac.aeInstitute of Public Health, United Arab Emirates University, Al Ain, Abu Dhabi

Introduction: Hyperlipidemia, a silent asymptomatic disease, contributes significantly to cardiovascular disease (CVD) mortality and morbidity in the Gulf Cooperation Council (GCC) region. One of the facets of preventing CVD endpoint is medication adherence to lipid-lowering drugs (LLDs). Accordingly, this scoping review aims to explore the adherence to anti-hyperlipidemia medications among adults in the Arabian Gulf region.

Methods: Based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines, a literature search was conducted in Scopus, PubMed, Web of Science, and Google Scholar to screen for articles published from 2013 to 2023 reporting adherence or compliance to LLDs among adults aged 18 years or above with or without any co-morbidities in the GCC region. The quality of the paper was assessed using the AXIS checklist.

Discussion: The search yielded 139 articles, six meeting our inclusion criteria, all of which were cross-sectional. The researchers utilized varied measuring tools, resulting in heterogeneous results: good adherence in two studies, low adherence in three, and indefinite results in one. Younger age, polypharmacy, and female gender were the variables associated with higher drug noncompliance in one or more studies.

Conclusion: There is a research gap on anti-hyperlipidemia medication adherence in the Arabian Gulf region which calls for further research, especially higher evidence studies as no attempts have been made beyond the cross-sectional design. Public health implications of the results may include awareness interventions and cliniciandriven strategies to improve patient compliance.

Keywords: hyperlipidemia, dyslipidemia, adherence, Arabian Gulf, public health

[1] Pappan N, Rehman A. Dyslipidemia. StatPearls. StatPearls Publishing; 2023.

[2] Moneta G. Hyperlipidemia | Society for Vascular Surgery [Internet]. [cited 2023 Nov 5]. Available from: https://vascular.org/patients-and-referring-physicians/conditions/hyperlipidemia

[3] Zheng J, Wang J, Zhang Y, Xia J, Guo H, Hu H, et al. The global burden of diseases attributed to high low-density lipoprotein cholesterol from 1990 to 2019. Front Public Health. 2022;10:891929.

[4] World Health Organization. Raised cholesterol [Internet]. [cited 2023 Nov 5]. Available from: https: //www.who.int/data/gho/indicator-metadata-registry/imr-details/3236

[5] Manla Y, Almahmeed W. The pandemic of coronary heart disease in the Middle East and North Africa: What clinicians need to know. Curr Atheroscler Rep. 2023;1–15.

[6] Aljefree N, Ahmed F. Prevalence of cardiovascular disease and associated risk factors among adult population in the Gulf region: A systematic review. Adv Public Health. 2015;2015:1–23.

[7] Deshpande S, Quek RGW, Forbes CA, de Kock S, Kleijnen J, Gandra SR, et al. A systematic review to assess adherence and persistence with statins. Curr Med Res Opin. 2017;33(4):769–778.

[8] World Health Organization. Adherence to long-term therapies: Evidence for action. World Health Organization; 2003.

[9] Cheen MHH, Tan YZ, Oh LF, Wee HL, Thumboo J. Prevalence of and factors associated with primary medication non-adherence in chronic disease: A systematic review and meta-analysis. Int J Clin Pract. 2019;73(6):e13350.

[10] Al Qasem A, Smith F, Clifford S. Adherence to medication among chronic patients in Middle Eastern countries: review of studies. EMHJ-Eastern Mediterranean Health J. 2011;17(4):356-363.

[11] Kurdi S, Albannay R, Alsinan Z, Islam A. Evaluation of medication adherence among patients with chronic diseases in Saudi Arabia. Int J Clin Pract. 2021;75(7):e14253.

[12] Al-Noumani H, Al-Harrasi M, Jose J, Al-Naamani Z, Panchatcharam SM. Medication adherence and patients’ characteristics in chronic diseases: A national multi-center study. Clin Nurs Res. 2022;31(3):426–434.

[13] Zidan A, Awaisu A, El-Hajj MS, Al-Abdulla SA, Figueroa DCR, Kheir N. Medication-related burden among patients with chronic disease conditions: Perspectives of patients attending non-communicable disease clinics in a primary healthcare setting in Qatar. Pharmacy. 2018;6(3):85.

[14] Al Faraidy K, Akbar M, Shehri M, Aljarallah M, Hussein GA, Dashti R, et al. Multizonal observational study conducted by clinical practitioners on evolocumab use in subjects with hyperlipidemia in Saudi Arabia and Kuwait: Results from the ZERBINI study. PLoS One. 2023;18(1).

[15] Forbes CA, Deshpande S, Sorio-Vilela F, Kutikova L, Duffy S, Gouni-Berthold I, et al. A systematic literature review comparing methods for the measurement of patient persistence and adherence. Curr Med Res Opin. 2018 Sep 2;34(9):1613–1625.

[16] Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open [Internet]. 2016 Dec 1;6(12):e011458. Available from: http://bmjopen.bmj.com/content/6/12/e011458.abstract

[17] Alharbi MS, Alnasyan S, Almazroa G, Aldakheel FN, Albattah GA, AlHujilan AH, et al. Adherence to statin among diabetic patients in diabetic centers in Qassim Region, Saudi Arabia. Cureus. 2023;15(10).

[18] Allaham KK, Feyasa MB, Govender RD, Musa AMA, Alkaabi AJ, Elbarazi I, et al. Medication adherence among patients with multimorbidity in the United Arab Emirates. Patient Prefer Adherence. 2022;16:1187–200.

[19] Alwhaibi M, Altoaimi M, Alruthia Y, Meraya AM, Balkhi B, Aldemerdash A, et al. Adherence to statin therapy and attainment of LDL cholesterol goal among patients with type 2 diabetes and dyslipidemia. Patient Prefer Adherence. 2019;13:2111–2118.

[20] Al-Foraih M, Somerset S. Factors affecting adherence to statins in hypercholesterolemic Kuwaiti patients: A cross-sectional study. Medical Principles and Practice. 2017;26(1):35–40.

[21] Al Shammeri O, Stafford RS, Alzenaidi A, Al-Hutaly B, Abdulmonem A. Quality of medical management in coronary artery disease. Ann Saudi Med. 2014;34(6):488–493.

[22] Arafah M, Al-Hinai AT, Mahmeed WA, Al-Rasadi K, Tamimi OA, Herz SA, et al. Centralized pan-Middle East survey on the undertreatment of hypercholesterolemia: Results from the cepheus study in Arabian gulf countries. Angiology. 2014;65(10):919–926.

[23] Vupputuri S, Joski PJ, Kilpatrick R, Woolley JM, Robinson BE, Farkouh ME, et al. LDL cholesterol response and statin adherence among high-risk patients initiating treatment. Am J Manag Care. 2016;22(3):e106–e115.

[24] Farsaei S, Sabzghabaee AM, Amini M, Zargarzadeh AH. Adherence to statin therapy in patients with type 2 diabetes: An important dilemma. J Res Med Sci. 2015;20(2):109.

[25] Gehani AA, Al-Hinai AT, Zubaid M, Almahmeed W, Hasani MRM, Yusufali AH, et al. Association of risk factors with acute myocardial infarction in Middle Eastern countries: the INTERHEART Middle East study. Eur J Prev Cardiol. 2014;21(4):400–10.

[26] Said AH, Abd Rahim IS, Zaini NNBM, Nizam NIBS. Factors affecting adherence to lipid-lowering drugs: A scoping review. Oman Med J. 2023;38(4):e523.

[27] Alefishat E, Jarab AS, Al-Qerem W, Abu-Zaytoun L. Factors associated with medication non-adherence in patients with dyslipidemia. In: Healthcare. MDPI; 2021. p. 813.

[28] Barrios V, Soronen J, Carter AM, Anastassopoulou A. Lipid management across Europe in the realworld setting: a rapid evidence review. Curr Med Res Opin. 2021;37(12):2049–59.

[29] Ge L, Heng BH, Yap CW. Understanding reasons and determinants of medication non-adherence in community-dwelling adults: a cross-sectional study comparing young and older age groups. BMC Health Serv Res. 2023;23(1):905.

[30] Hope HF, Binkley GM, Fenton S, Kitas GD, Verstappen SMM, Symmons DPM. Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease. PLoS One. 2019;14(1):e0201196.

[31] Ray KK, Ference BA, Séverin T, Blom D, Nicholls SJ, Shiba MH, et al. World heart federation cholesterol roadmap 2022. Glob Heart. 2022;17(1).