title: Statin non-adherence and residual cardiovascular risk: There is need for substantial improvement.
abstract: 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.
authors.affiliation: Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland; Healthy Aging Research Centre, Medical University of Lodz, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute, Lodz, Poland. Electronic address: maciejbanach@aol.co.uk.
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.affiliation: 3rd Department of Internal Medicine, 1st University of Medicine, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Stulc
authors.affiliation: Amgen (Europe) GmbH, Zug, Switzerland.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Dent
authors.affiliation: CGH Medical Center, Sterling, IL, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy*; D008076:Cholesterol, HDL / Q000037:antagonists & inhibitors / Q000097:blood; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D055118:Medication Adherence; D063806:Myalgia / Q000139:chemically induced; D000091362:PCSK9 Inhibitors; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000139:chemically induced; D000071449:Proprotein Convertase 9
chemical_list: D008076:Cholesterol, HDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000091362:PCSK9 Inhibitors; C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9
keywords: Cardiovascular risk; Discontinuation; HDL-C; Non-adherence; PCSK9; Statin; Statin-associated muscle symptoms