Statin non-adherence and residual cardiovascular risk: There is need for substantial improvement

Int J Cardiol. 2016 Dec 15:225:184-196. doi: 10.1016/j.ijcard.2016.09.075. Epub 2016 Sep 26.


Although statin therapy has proven to be the cornerstone for prevention and treatment of cardiovascular disease (CVD), there are many patients for whom long-term therapy remains suboptimal. The aims of this article are to review the current complex issues associated with statin use and to explore when novel treatment approaches should be considered. Statin discontinuation as well as adherence to statin therapy remain two of the greatest challenges for lipidologists. Evidence suggests that between 40 and 75% of patients discontinue their statin therapy within one year after initiation. Furthermore, whilst the reasons for persistence with statin therapy are complex, evidence shows that low-adherence to statins negatively impacts clinical outcomes and residual CV risk remains a major concern. Non-adherence or lack of persistence with long-term statin therapy in real-life may be the main cause of inadequate low density lipoprotein cholesterol lowering with statins. There is a large need for the improvement of the use of statins, which have good safety profiles and are inexpensive. On the other hand, in a non-cost-constrained environment, proprotein convertase subtilisin/kexin type 9 inhibitors should arguably be used more often in those patients in whom treatment with statins remains unsatisfactory.

Keywords: Cardiovascular risk; Discontinuation; HDL-C; Non-adherence; PCSK9; Statin; Statin-associated muscle symptoms.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / drug therapy*
  • Cholesterol, HDL / antagonists & inhibitors
  • Cholesterol, HDL / blood
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hypercholesterolemia / blood
  • Hypercholesterolemia / drug therapy*
  • Medication Adherence*
  • Myalgia / chemically induced
  • PCSK9 Inhibitors
  • Randomized Controlled Trials as Topic / methods
  • Risk Factors
  • Sleep Wake Disorders / chemically induced


  • Cholesterol, HDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • PCSK9 Inhibitors
  • PCSK9 protein, human