Statins are the most powerful lipid lowering drugs in clinical practice. However, the efficacy of statin therapy, as seen in randomized
control trials, is undermined by the documented non-adherence observed in clinical practice. Understanding the clinical consequences
of statin non-adherence is an important step in implementing successful interventions aimed at improving adherence. Our previous
systematic review included a literature search up to January 2010 on the effects of statin non-adherence or discontinuation on cardiovascular
(CV) and cerebrovascular outcomes. We provide an update to this publication and a review of promising interventions that have
reported a demonstrated improvement in statin adherence. Through a systematic literature search of PubMed, Ovid Medline, Ovid Embase,
CINAHL, Cochrane Library and Web of Science, out of the 3440 initially identified, 13 studies were selected. Non-adherence in a
primary prevention population was associated with a graded increase in CV risk. Individuals taking statins for secondary prevention were
at particular risk when taking statin with highly variable adherence. Moreover, particular attention is warranted for non-adherence in diabetic
and rheumatoid arthritis populations, as non-adherence is significantly associated with CV risk as early as 1 month following discontinuation.
Statin adherence, therefore, represents an important modifiable risk factor. Numerous interventions to improve adherence
have shown promise, including copayment reduction, automatic reminders, mail-order pharmacies, counseling with a health professional,
and fixed-dose combination therapy. Given the complexity of causes underlying statin non-adherence, successful strategies will likely
need to be tailored to each patient.
Keywords: Statins, adherence, discontinuation, cardiovascular disease, cerebrovascular disease, interventions, primary prevention, secondary
prevention, risk assessment.
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