The following are key points to remember from a systematic review for management of patients with dyslipidemia:

1. Although statins are a mainstay of treatment for patients with dyslipidemia who are at risk for cardiovascular disease (CVD), a substantial subset of patients become intolerant to statins because of adverse effects.
2. Strategies to improve patients’ tolerance of and adherence to statins may enhance the effectiveness of dyslipidemia treatment in those at risk for cardiovascular disease.
3. Patients cite a wide variety of reasons for statin nonadherence, including concerns over adverse effects and risk; however, these concerns are not strongly associated with reduced statin use.
4. There is moderate-strength evidence that intensified patient care can increase adherence to statin regimens at follow-up longer than 6 months in patients receiving statins for primary or secondary prevention of CVD.
5. Intensified patient care that includes combinations of education, telephone interaction with providers, pharmaceutical care programs, and other interventions can be individually tailored on the basis of a patient’s specific reasons for nonadherence.
6. Although evidence supporting rechallenge with the same or a different statin or nondaily statin use is limited to observational studies, for most patients, the potential benefits of statin adherence outweigh the risks for adverse events from continued statin use.
7. There are currently weak recommendations favoring intensified patient care or rechallenge with the same or a different statin (or lower dose) and, if the latter approach fails, a trial of intermittent (nondaily) statins.
8. Clinical practice guidelines recommend that a washout period should be implemented before rechallenge to determine whether an adverse event was truly related to the statin.
9. At this time, evidence is considered insufficient to allow any recommendation about vitamin D to improve statin adherence.
10. Future research could improve the strength of evidence for various interventions by designing more randomized controlled trials with longer follow-up for intensified patient care programs, studies that compare daily and nondaily statin use in patients with prior intolerance, more randomized controlled trials of vitamin D supplements, and prospective studies that evaluate statin rechallenge in nonadherent patients.

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

Keywords: Cardiovascular Diseases, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence, Patient Care, Pharmaceutical Services, Primary Prevention, Risk Factors, Secondary Prevention, United States Department of Veterans Affairs, Vitamin D

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