Clinical Report: Statin Therapy Adherence and Influencing Factors

Overview

This systematic review and meta-analysis of 76 studies involving nearly 6 million adults found that the pooled prevalence of good adherence to statin therapy (≥80% medication use) was 62.4%. Adherence was lower in primary prevention compared to secondary prevention and was influenced by demographic and clinical factors including age, sex, race, comorbidities, and polypharmacy.

Background

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality globally, with dyslipidemia being a major modifiable risk factor. Statins are the cornerstone of lipid-lowering therapy to prevent ASCVD events. However, adherence to long-term statin therapy remains suboptimal, limiting the effectiveness of treatment. Understanding adherence patterns and associated factors is critical to improving cardiovascular outcomes and optimizing healthcare resource utilization.

Data Highlights

Key Findings

• Overall adherence to statin therapy is suboptimal, with only about 62.4% of patients achieving good adherence (≥80% medication use).
• Adherence is lower in primary prevention populations (57.5%) compared to secondary prevention (64.4%).
• Lower adherence is associated with female sex, younger age, Black or Hispanic ethnicity, current smoking, depression, and heart failure.
• Higher adherence is observed among older adults, patients with myocardial infarction, hypertension, multiple comorbidities, and those receiving polypharmacy (≥5 medications).
• Polypharmacy is linked to better adherence, possibly due to more intensive medical supervision or higher perceived cardiovascular risk.
• Primary non-adherence was not reported in the included studies, and findings were consistent across sensitivity analyses.

Clinical Implications

Clinicians should recognize that nearly 4 in 10 patients prescribed statins do not maintain adequate adherence, particularly in primary prevention and among certain demographic groups such as women and younger adults. Targeted interventions addressing modifiable factors like depression and smoking, as well as enhanced support for high-risk populations including those with heart failure or minority ethnicities, are essential. Monitoring adherence and leveraging polypharmacy contexts may improve long-term statin use and cardiovascular outcomes.

Conclusion

Statin adherence remains a significant challenge despite proven benefits in ASCVD prevention. Tailored strategies focusing on demographic and clinical risk factors are needed to enhance adherence and optimize cardiovascular risk reduction.

References

1. Systematic Review and Meta-Analysis, 2025 -- Assessment of Statin Therapy Adherence