Overcoming Barriers to Statin Adherence

Arden Bui, PharmD Candidate 2021; Juwon Kwon, PharmD; Jennifer Kim, PharmD, BCPS, BCACP, CPP; Austin Lucas, PharmD


US Pharmacist. 2019;44(6):19-22. 

In This Article

Predictors of Statin Nonadherence

Experience with, or apprehension about, adverse events such as muscle-related effects, cognitive or memory problems, and new-onset diabetes are major causes of statin discontinuation.[8,9] Patient demographics also influence adherence. Adults aged 50 years or younger and aged 70 years or older, females, African American or Hispanic patients, low-income patients, those with low health literacy, and patients without coronary heart disease (CHD) have displayed lower statin adher-ence.[10–13] In contrast, factors such as middle age, male sex, white ethnicity, higher income, CVD, comorbidities, follow-up monitoring, and cardiologist care were predictors of adherence. In older patients, diabetes and mental health comorbidities have been linked to statin nonadherence.[14–16]

"A retrospective study among coronary heart disease patients showed that more than one-third of patients were nonadherent to statin therapy after initiation because of high copays."

Financial barriers can also predict nonadherence. In retrospective cohort studies, veterans with no copays were more likely to adhere to statin therapy, and copays were negatively associated with adherence for middle-income and lower-middle-income patients.[17] A retrospective study among CHD patients showed more than one-third of patients were nonadherent to statin therapy after initiation because of high copays. Patients with copays of $20 or more were significantly less likely to be adherent compared with copays of $10 or less.[18] Choudhry and colleagues found that eliminating copays for CVD medications (statins, beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers) improved adherence and reduced the rate of a first major vascular event (11% vs. 12.8%; hazard ratio [HR], 0.86; 95% CI, 0.74–0.99).[19]