Prevention & lipidsCohort study
Statin adherence among patients with hypertension in Swedish primary health care: a QregPV cohort study using explainable machine learning
- retrospective register-based cohort study
- explainable machine learning with XGBoost and SHAP values
- adjusted multilevel regression
Authors' conclusion
Only 60% of patients achieved adequate statin adherence, which varied substantially by indication. Patient- and provider-level factors identified could guide targeted interventions to optimize preventive cardiovascular care.
Study context
- Population
- Patients with hypertension who initiated statin therapy in 2012–2015 in Swedish primary health care (large Swedish region)mean age 66 years, 48% women
- Participants
- 30,497 patients
- Exposure
- Associations between baseline patient characteristics and adequate statin adherence (proportion of days covered (PDC) > 80%)
Main finding
As reported in the abstract
Statin adherence (proportion of days covered, PDC) · 2 years after initiation
mean 2-year PDC
73.2%
adequate adherence (PDC > 80%)
60.2%
Observational data: associations, not effects.
Further findings
Characteristics associated with adequate adherence (five most important by SHAP values)
| Comparison | OR (95% CI) | |
|---|---|---|
| dispensed antithrombotic therapy · adjusted multilevel regression | 1.38 (1.26–1.50) | |
| initiation with atorvastatin · adjusted multilevel regression | 1.33 (1.24–1.44) | |
| 0.512Odds ratio (log scale) |
| Outcome | Values | OR (95% CI) | |
|---|---|---|---|
| Characteristics associated with adequate adherence (five most important by SHAP values) — 10-year increase in age · per 10-year increase · adjusted multilevel regression | 1.14 (1.12–1.17) | ||
| 0.512Odds ratio (log scale) |
| Outcome | Values | MOR (95% CI) |
|---|---|---|
| Adequate adherence by indication | primary prevention 54.0% · diabetes without cardiovascular disease 61.3% · secondary prevention 65.5% | |
| Characteristics associated with adequate adherence (five most important by SHAP values) — primary health care centre · adjusted multilevel regression | 1.16 (1.12–1.20) |
- Characteristics associated with adequate adherence (five most important by SHAP values) — countries of birth outside Sweden (OR range)
- 0.73-0.78
- Adequate adherence by indication: differed by indication (P < 0.001)
Original publication
Statin adherence among patients with hypertension in Swedish primary health care: a QregPV cohort study using explainable machine learning. Eur Heart J Cardiovasc Pharmacother. Published 29 June 2026. doi:10.1093/ehjcvp/pvag048
Summarised from the published abstract; every number is checked against it