Self-reported adherence to nonpharmacological treatment and association with mortality over 6 years: population-based study in older persons with hypercholesterolemia.

Objectives: To determine the prevalence of self-reported adherence of older persons with hypercholesterolemia to nonpharmacological treatment prescribed by a physician and to describe its association with mortality.

Design: Population-based prospective study.

Setting: Home interview and physical examination at baseline.

Participants: Four thousand eight persons representative of the noninstitutionalized Spanish population aged 60 and older.

Measurements: Primary exposure variable was self-reported adherence to nonpharmacological treatment (weight control or loss, increased physical activity, and reduced saturated fat or cholesterol intake) in the 918 persons with known hypercholesterolemia in 2001. The outcome variable was mortality from all causes between 2001 and 2007. The association between self-reported adherence to nonpharmacological treatment and total mortality was studied using Cox models adjusted for main confounders.

Results: Most (83.8%) persons with known hypercholesterolemia reported adherence to at least one nonpharmacological measure, and 29.5% adhered to three measures. Those who reported increasing their physical activity had less mortality than those who did not (hazard ratio (HR)=0.68, 95% confidence interval (CI)=0.46-0.99; P<.05). Persons with hypercholesterolemia who reported adherence to one, two, or all three nonpharmacological measures had lower mortality than those who reported adherence to none of the measures (49%, 41%, and 60%, respectively, P for linear trend .002). No independent association with mortality was found for weight control or loss or dietary measures.

Conclusion: Most of this population with known hypercholesterolemia reported adherence to at least one physician-prescribed nonpharmacological measure. Reported adherence to all three measures was associated with the lowest mortality.