Nonadherence to statins: individualized intervention strategies outside the pill box

Abstract

Poor adherence to statin therapy is linked to significantly increased risk of cardiovascular events and death. Unfortunately, adherence to statins is far from optimal. This is an alarming concern for patients prescribed potentially life-saving cholesterol-lowering medication, especially for those at high risk of cardiovascular events. Research on statin adherence has only recently garnered broader attention; hence, major reasons unique to adherence to statin therapy need to be identified as well as suggestions for countermeasures. An integrated approach to minimizing barriers and enhancing facilitation at the levels of the patient, provider, and health system can help address adherence issues. Health care professionals including physicians, pharmacists, and nurses have an obligation to improve patient adherence, as routine care. In order to achieve sustained results, a multifaceted approach is indispensable.

Keywords: cardiovascular disease; myopathy; nocebo; nonadherence; statins.

Figure 1

Factors associated with statin nonadherence.

Figure 2

Interventions for improving medication adherence. Notes: Overall, the interventions can be differentiated as “before” and “after” prescription interventions. The strategies are multimodal varying from “patient education/counseling” to “adopting team-based” approaches. Effective approaches must involve strong partnerships between patients and health providers.