Interventions to Improve Statin Tolerance and Adherence
- Authors:
- Reston JT, Buelt A, Donahue MP, et al.
- Citation:
- Interventions to Improve Statin Tolerance and Adherence in Patients at Risk for Cardiovascular Disease: A Systematic Review for the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Dyslipidemia. Ann Intern Med 2020;173:806-812.
The following are key points to remember from a systematic review for management of patients with dyslipidemia:
- 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.
- Strategies to improve patients’ tolerance of and adherence to statins may enhance the effectiveness of dyslipidemia treatment in those at risk for cardiovascular disease.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- At this time, evidence is considered insufficient to allow any recommendation about vitamin D to improve statin adherence.
- 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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