Nonadherence to lipid‐lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease

Abstract

Despite the availability of effective therapies that lower low‐density lipoprotein cholesterol (LDL‐C) levels in patients with atherosclerotic cardiovascular disease, many eligible patients are inadequately treated and their LDL‐C levels remain suboptimal. Patient nonadherence to lipid‐lowering therapy (LLT) is a major contributor to the failure of LDL‐C goal attainment. Several factors have been identified as contributing to LLT nonadherence, including healthcare disparities due to socioeconomic status, age, race, sex, and cost; limited access to healthcare; perceived side effects associated with LLT; health literacy; and the presence of comorbidities. Suboptimal LLT use has also been associated with clinician factors, including failure to identify patients who require LDL‐C reassessment, insufficient LDL‐C monitoring, and clinical inertia such as a lack of therapy intensification. Several strategies to enhance LLT adherence have been shown to be effective, including the implementation of educational initiatives and tools for both patients and physicians, the use of clinical protocols and algorithms to identify patients at risk and optimize treatment, and improvements in electronic healthcare records. Pharmacy‐based programs designed to help patients with prescription refills, including reminders or the use of prescription delivery by mail, have also proven effective. Drugs requiring frequent administration can represent a barrier to treatment adherence; therefore, newer, more effective LLTs with lower frequency of administration and lower potential for polypharmacy may improve patient adherence to LLT. Implementation of strategies to identify patients at risk for LLT nonadherence and the use of flexible tools such as telemedicine to overcome geographical barriers may improve LLT adherence.

Strategies of improving adherence to lipid-lowering therapy in patients with atherosclerotic cardiovascular disease

“…However, there exists a significant gap between what guidelines recommend for lipid-lowering therapy in ASCVD patients and what occurs in real-world practice [7,8]. In part, this is related to under-prescribing of statin intensity, which is most often due to statin intolerance, clinical inertia, insufficient monitoring of LDL-C levels and the difficulty of prescribing and high cost of some nongeneric lipid-lowering therapies such as the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors [9 ▪ ].…”

Adherence to pharmacotherapy: sine qua non for reducing cumulative risk of premature coronary disease in familial hypercholesterolemia

“…Statins are a core treatment for FH and ASCVD, and poor adherence to statin therapy or discontinuation may diminish treatment benefit for the prevention of ASCVD in FH. Numerous studies have reported high rates of nonadherence to statin therapy in the real-world setting [5,26]. The magnitude and impact of poor adherence is higher in developing countries, given the disparities in health resources and inequalities in access to healthcare [5].…”

“…HCPs also need to be specifically trained in adherence management (such as behavioural counselling); shared strategies involving pharmacists and nurses in general practice can promote adherence to treatment [2 ▪▪ ]. HCPs should manage FH patients by following guideline-directed treatment recommendations [5]. A definite genetic diagnosis for FH may also motivate HCPs following guideline-recommended treatments [53].…”

“…We review several barriers to pharmacological treatment and propose implementation strategies for improving adherence in patients with FH. Readers should also refer to more general reviews on this topic [5,6,7 ▪▪ ]…”

Predicting Statin Adherence Following Hospital Discharge for Acute Coronary Syndromes: What’s the Score?

“…Also important in future work will be to establish how generalisable are the findings, given the patients were drawn from a specific programme using an invasive management strategy and the New Zealand health care system where medication cost subsidies likely differ from those found elsewhere. Lastly, this novel and interesting work highlights the importance of education initiatives, shared decision making between patients and health professionals, and involvement of pharmacy-based programs pre- and post-discharge [ 8 ]; and, emphasises the importance of ongoing evaluation of adherence with patients and the need for further investigation into this important area.…”