Intensified care, reduced dose may improve statin adherence

Strategies to improve adherence to statin therapy, such as intensified patient care and rechallenge with the same or a different statin (or a lower dose), among patients at risk for cardiovascular disease appear to be effective, suggests a recent study. However, the strength of evidence for most intervention is low or very low.

The investigators searched the databases of Medline, Embase, PubMed, and the Cochrane Library from December 2013 through May 2019 for systematic reviews (SRs), randomized controlled trials (RCTs), and cohort studies in the English language that examined interventions for improving statin tolerance and adherence. One investigator abstracted data and evaluated study quality, and another one checked abstractions and assessments for accuracy.

One SR, one RCT, and four cohort studies met the eligibility criteria. In the SR, results showed that intensified patient care improved adherence and reduced levels of total serum cholesterol and low-density lipoprotein cholesterol (LDL-C) at ≥6 months of follow-up. Nondaily statin dosing compared with treatment cessation reduced total cholesterol and LDL-C levels.

In one large cohort study, more than 90 percent of patients who discontinued statin therapy could be rechallenged with the same or a different statin and be adherent 1 year after statin-related adverse event resulted in discontinuation. Two small cohort studies reported that more than 90 percent of patients who were previously intolerant to statins and who had low baseline levels of vitamin D successfully adhered to statins 1 year after vitamin D supplementation.

The current study, however, was limited by its design (qualitative synthesis of new evidence with existing meta-analysis) and methodological shortcomings in the included articles.