title: Understanding patients' perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review.
abstract: BACKGROUND
  Dyslipidaemia leads to atherosclerosis and is a major risk factor for cardiovascular diseases. In clinical trials, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been shown to effectively reduce dyslipidaemia. Despite the availability and accessibility of statins, myocardial infarctions and cerebrovascular accidents remain among the top causes of mortality in developed countries, including Singapore. This enigma could be attributed to suboptimal adherence to statin therapy. The present literature review aimed to evaluate patients' perceptions of statin therapy.
  
  
  METHODS
  We searched PubMed and other databases for articles published in English from October 1991 to May 2012 containing keywords such as 'patient', 'views', 'perceptions', 'adherence', 'statin' and 'dyslipidaemia'. Of the 122 eligible studies retrieved, 58 were reviewed. The findings were categorised and framed in accordance with the Health Belief Model.
  
  
  RESULTS
  Patients with dyslipidaemia appeared to underestimate their susceptibility to dyslipidaemia-related complications, partly due to their demographic profiles. Failure to appreciate the severity of potential complications was a major hindrance toward adherence to statin therapy. Other factors that affected a patient's adherence included lack of perceived benefits, perceived side effects, the cost of statins, poor physician-patient relationship, and overestimation of the effectiveness of diet control as a treatment modality.
  
  
  CONCLUSIONS
  Existing evidence suggests that the cause of poor adherence to statin therapy is multifactorial. The use of the Health Belief Model to present the results of our literature review provides a systematic framework that could be used to design a patient-centric approach for enhancing adherence to statin therapy.
authors.affiliation: Department of General Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. cheeyingjie.chee@mohh.com.sg.
authors.forename: Ying Jie
authors.initials: YJ
authors.lastname: Chee
authors.forename: Hian Hui Vincent
authors.initials: HH
authors.lastname: Chan
authors.forename: Ngiap Chuan
authors.initials: NC
authors.lastname: Tan
mesh_terms: D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D004032:Diet; D050171:Dyslipidemias / Q000188:drug therapy*; D006266:Health Education; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D055118:Medication Adherence; D009203:Myocardial Infarction / Q000188:drug therapy; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D012307:Risk Factors; D012846:Singapore; D020521:Stroke / Q000188:drug therapy
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors