Strategies to improve adherence with medications in chronic, ‘silent’ diseases representing high cardiovascular risk

Given the burden of illness related to diabetes, hypertension and dyslipidemia, it is very important to achieve glycemic control, optimal blood pressure and low-density lipoprotein cholesterol (LDL-C) in order to avoid severe long-term complications. Patients' adherence with, and persistence to, the treatment regimen is a critical factor in achieving this goal. Medication taking behavior in these chronic, nonsymptomatic ('silent') diseases is generally low, although a wide range of results have been reported. The literature has shown that nonadherence to medications is a multidimensional phenomenon; relating factors can be grouped into the following categories: health system related, social/economic, condition-related, therapy-related and patient-related factors. Although several interventions exist to improve patients' medication-taking behavior, none appear to be clearly superior to others. The key steps to improve adherence are to identify individual barriers and to develop patient-specific self-management plans to overcome them (called 'patient-centric' approach). When developing intervention strategies one should always remember that 'one size does not fit all'. Well designed (but not randomized), observational studies (for example, patient registries) may be required with sufficient follow-up periods and multiple adherence measurements in order to advance the field.