The following are key points to remember from this review on interventions to improve statin tolerance and adherence in patients at risk for cardiovascular disease (CVD):

1. Despite the well-established benefits of statin therapy among patients at increased risk for CVD, a significant number of such patients become intolerant to statin therapy, resulting in lower adherence and thus effectiveness. Nonadherence rates have been observed to be as high as 50% at 1 year in some studies.
2. Among patients who are nonadherent to statin therapy, intensifying patient care including education, provider-patient telephone visits, and pharmaceutical care programs may help improve adherence to statins. These methods can be tailored to the needs of individual patients. However, current data are limited by the short-term follow-up on statin adherence among participants in these studies.
3. Vitamin D supplementation has been used to reduce statin intolerance among patients with low vitamin D levels with some promising results. However, most randomized controlled trial (RCT) studies were subject to biases including lack of blinding, or selection bias among the cohort studies.
4. Evidence for rechallenging patients with the same or a different statin is predominantly limited to observational studies; however, for most patients, the potential benefits for statin use outweigh the risk of statin-related adverse events. The same is true for nondaily statin use.
5. A washout period should be implemented prior to rechallenging with statins to help determine if the adverse event was related to the statin.
6. Future research is recommended to include RCTs to compare daily and nondaily statin use in patients with a history of statin intolerance. RCTs to examine use of vitamin D supplements and statin rechallenge are also recommended.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Cardiovascular Diseases, Drug Tolerance, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence, Patient Care, Patient Compliance, Primary Prevention, United States Department of Defense, United States Department of Veterans Affairs

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