---
title: "Statin adherence in Swedish primary care: predictors from an explainable machine learning cohort"
id: "pubmed-42366593"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42366593"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42366593/"
doi: "10.1093/ehjcvp/pvag048"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Statin adherence in Swedish primary care: predictors from an explainable machine learning cohort
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42366593
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42366593/)
- **DOI:** [10.1093/ehjcvp/pvag048](https://doi.org/10.1093%2Fehjcvp%2Fpvag048)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective register-based cohort studied **statin adherence** over 2 years in patients with hypertension who initiated statin therapy in 2012–2015 in a large Swedish region. - The cohort included 30,497 patients (mean age 66 years; 48% women). Adherence was measured as proportion of days covered (**PDC**) over 2 years. - Mean 2-year PDC was 73.2%; 60.2% of patients reached adequate adherence (PDC > 80%). - Adequate adherence varied by indication: 54.0% in **primary prevention**, 61.3% in diabetes without cardiovascular disease, and 65.5% in **secondary prevention** (P < 0.001). - The study used explainable machine learning (XGBoost) with **SHAP values** to rank baseline predictors of adherence and supplemented findings with adjusted multilevel regression reporting odds ratios (ORs) and median odds ratios (MORs). - The five most important characteristics associated with adequate adherence were: dispensed **antithrombotic therapy** (OR 1.38), primary health care centre (provider-level effect; MOR 1.16), 10-year increase in age (OR 1.14), initiation with **atorvastatin** (OR 1.33), and countries of birth outside Sweden (OR range 0.73–0.78). - Authors conclude that only about 60% achieved adequate adherence and that both patient-level and provider-level factors could inform targeted interventions to improve preventive cardiovascular care. - The article is published in Eur Heart J Cardiovasc Pharmacother (2026) and is a multicentre, free-access study. Conflict of interest disclosed for one author receiving unrelated honoraria.
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42366593/#linkout) Title & authors Abstract Conflict of interest statement Similar articles Publication types MeSH terms Substances Related information Grants and funding LinkOut - more resources Multicenter Study Eur Heart J Cardiovasc Pharmacother Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Cardiovasc+Pharmacother%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Cardiovasc+Pharmacother%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42366593/) . 2026 Sep 22;12(6):458-467. doi: 10.1093/ehjcvp/pvag048. # Statin adherence among patients with hypertension in Swedish primary health care: a QregPV cohort study using explainable machine learning [Johan Sandslätt](https://pubmed.ncbi.nlm.nih.gov/?term=Sandsl%C3%A4tt+J&cauthor_id=42366593)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-1 "Närhälsan Krokslätt Health Care Centre, Fredåsgatan 13, 431 67 Gothenburg, Sweden.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden."), [Kristina Bengtsson Boström](https://pubmed.ncbi.nlm.nih.gov/?term=Bengtsson+Bostr%C3%B6m+K&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-3 "Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden."), [Maria Åberg](https://pubmed.ncbi.nlm.nih.gov/?term=%C3%85berg+M&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-4 "Region Västra Götaland, Regionhälsan, 405 30 Gothenburg, Sweden."), [Johan-Emil Bager](https://pubmed.ncbi.nlm.nih.gov/?term=Bager+JE&cauthor_id=42366593)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-5 "Department of Emergency Medicine, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-6 "Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden."), [Koen Simons](https://pubmed.ncbi.nlm.nih.gov/?term=Simons+K&cauthor_id=42366593)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-7 "Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden."), [Georgios Mourtzinis](https://pubmed.ncbi.nlm.nih.gov/?term=Mourtzinis+G&cauthor_id=42366593)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-6 "Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-8 "Department of Medicine and Emergency Care Mölndal, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden."), [Per Hjerpe](https://pubmed.ncbi.nlm.nih.gov/?term=Hjerpe+P&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-3 "Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden."), [Tobias Andersson](https://pubmed.ncbi.nlm.nih.gov/?term=Andersson+T&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#full-view-affiliation-3 "Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden.") Affiliations Expand ### Affiliations * 1 Närhälsan Krokslätt Health Care Centre, Fredåsgatan 13, 431 67 Gothenburg, Sweden. * 2 General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden. * 3 Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden. * 4 Region Västra Götaland, Regionhälsan, 405 30 Gothenburg, Sweden. * 5 Department of Emergency Medicine, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden. * 6 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden. * 7 Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden. * 8 Department of Medicine and Emergency Care Mölndal, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden. * PMID: **42366593** * DOI: [ 10.1093/ehjcvp/pvag048 ](https://doi.org/10.1093/ehjcvp/pvag048) Free article Item in Clipboard Multicenter Study # Statin adherence among patients with hypertension in Swedish primary health care: a QregPV cohort study using explainable machine learning Johan Sandslätt et al. Eur Heart J Cardiovasc Pharmacother. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur Heart J Cardiovasc Pharmacother Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Cardiovasc+Pharmacother%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Cardiovasc+Pharmacother%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42366593/) . 2026 Sep 22;12(6):458-467. doi: 10.1093/ehjcvp/pvag048. ### Authors [Johan Sandslätt](https://pubmed.ncbi.nlm.nih.gov/?term=Sandsl%C3%A4tt+J&cauthor_id=42366593)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-1 "Närhälsan Krokslätt Health Care Centre, Fredåsgatan 13, 431 67 Gothenburg, Sweden.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden."), [Kristina Bengtsson Boström](https://pubmed.ncbi.nlm.nih.gov/?term=Bengtsson+Bostr%C3%B6m+K&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-3 "Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden."), [Maria Åberg](https://pubmed.ncbi.nlm.nih.gov/?term=%C3%85berg+M&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-4 "Region Västra Götaland, Regionhälsan, 405 30 Gothenburg, Sweden."), [Johan-Emil Bager](https://pubmed.ncbi.nlm.nih.gov/?term=Bager+JE&cauthor_id=42366593)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-5 "Department of Emergency Medicine, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-6 "Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden."), [Koen Simons](https://pubmed.ncbi.nlm.nih.gov/?term=Simons+K&cauthor_id=42366593)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-7 "Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden."), [Georgios Mourtzinis](https://pubmed.ncbi.nlm.nih.gov/?term=Mourtzinis+G&cauthor_id=42366593)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-6 "Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-8 "Department of Medicine and Emergency Care Mölndal, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden."), [Per Hjerpe](https://pubmed.ncbi.nlm.nih.gov/?term=Hjerpe+P&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-3 "Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden."), [Tobias Andersson](https://pubmed.ncbi.nlm.nih.gov/?term=Andersson+T&cauthor_id=42366593)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-2 "General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42366593/#short-view-affiliation-3 "Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden.") ### Affiliations * 1 Närhälsan Krokslätt Health Care Centre, Fredåsgatan 13, 431 67 Gothenburg, Sweden. * 2 General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden. * 3 Regionhälsan R&D Centre, Skaraborg Primary Care, 541 80 Skövde, Sweden. * 4 Region Västra Götaland, Regionhälsan, 405 30 Gothenburg, Sweden. * 5 Department of Emergency Medicine, Sahlgrenska University Hospital, 413 46 Gothenburg, Sweden. * 6 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden. * 7 Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden. * 8 Department of Medicine and Emergency Care Mölndal, Sahlgrenska University Hospital, 431 80 Mölndal, Sweden. * PMID: **42366593** * DOI: [ 10.1093/ehjcvp/pvag048 ](https://doi.org/10.1093/ehjcvp/pvag048) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** Evidence regarding statin adherence among patients with hypertension in primary care is limited. We assessed statin adherence in Swedish primary care and examined associations between patient characteristics and adherence. **Methods and results:** In this retrospective register-based cohort study from a large Swedish region, data from all primary health care centres were linked to data on comorbidities, dispensed drugs, and socioeconomic factors. Patients with hypertension who initiated statin therapy in 2012-2015 were included. Adherence during 2 years after initiation was measured using the proportion of days covered (PDC). Explainable machine learning with XGBoost and SHAP values identified baseline characteristics associated with adherence. Associations were estimated using adjusted multilevel regression and presented as odds ratios (ORs) and median odds ratios (MORs). Among 30 497 patients (mean age 66 years; 48% women), the mean 2-year PDC was 73.2%, while 60.2% achieved adequate adherence (PDC > 80%). Adequate adherence differed by indication (P < 0.001): 54.0% in primary prevention, 61.3% in diabetes without cardiovascular disease, and 65.5% in secondary prevention. The five most important characteristics associated with adequate adherence according to SHAP values were dispensed antithrombotic therapy (OR 1.38, 95% CI 1.26-1.50), primary health care centre (MOR 1.16, 95% CI 1.12-1.20), 10-year increase in age (OR 1.14, 95% CI 1.12-1.17), initiation with atorvastatin (OR 1.33, 95% CI 1.24-1.44), and countries of birth outside Sweden (OR range 0.73-0.78). **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. **Keywords:** Cardiovascular diseases; Hyperlipidaemia; Preventive care; Primary health care; Statins; Treatment adherence. © The Author(s) 2026. Published by Oxford University Press on behalf of European Society of Cardiology. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflict of interest: J.-E.B. has received speaker honoraria from AstraZeneca and Boehringer-Ingelheim for lectures not related to this manuscript.
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