Current Use of Statins for Primary Prevention of Cardiovascular Disease: Patient-Reported Outcomes and Adherence
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Current Use of Statins for Primary Prevention of Cardiovascular Disease: Patient-Reported Outcomes and Adherence Scott A. Coon 1 & Emily J. Ashjian 1 & Megan C. Herink 1
Published online: 19 May 2016 # Springer Science+Business Media New York 2016
Abstract Recent updates in atherosclerotic cardiovascular disease (ASCVD) risk assessment and management guidelines have expanded the global number of statin-indicated persons, prompting clinicians to rethink conversations about initiating new statin therapy. The benefits of statins in primary prevention of ASCVD are less convincing than in secondary prevention, although higher ASCVD risk is associated with greater statin benefit. Therefore, clinicians must engage patients in a shared decision about starting new statin therapy, which should involve discussion about the risks and benefits of therapy, patient perceptions, and health status. Research has identified nonadherence to statin therapy as a factor associated with reduced clinical benefits of statin therapy. Clinicians should be aware of patient-specific factors associated with nonadherence and implement strategies to improve adherence as indicated. Data on the impact of adherence improvement strategies and the accuracy of how we currently measure adherence are lacking. Additionally, research focusing on patient preferences and reported outcomes would greatly inform practice and improve clinician–patient relationships.
Keywords Hydroxymethylglutaryl-CoA reductase inhibitors . Medication adherence . Primary prevention . Cardiovascular diseases This article is part of the Topical Collection on Cardiovascular Risk Health Policy * Scott A. Coon [email protected]
1
Oregon Health & Science University College of Pharmacy, Oregon State University, 2770 SW Moody Ave., CL5CP, Portland, OR 97201, USA
Introduction The World Health Organization (WHO) 2013 Global Action Plan proposes a 25 % relative risk reduction in premature mortality from preventable diseases, including cardiovascular disease (CVD), by the year 2020 [1]. In order to achieve this goal, the WHO has proposes an increase in the proportion of eligible patients receiving CVD-preventing therapies up to a threshold of at least 50 % [1]. Improved use of statins for primary prevention of CVD is an important first step toward reducing cardiovascular morbidity and mortality. Evidence supporting statin use for primary prevention shows a 9–17 % significant reduction in risk for all-cause mortality compared to control groups [2••, 3, 4], and even greater reductions in risk for atherosclerotic cardiovascular disease (ASCVD) events after at least 1 year of treatment, with no evidence of serious or life-threatening harm [2••, 3, 4]. Although the exact threshold for initiating statin therapy for primary prevention of CVD continues to be debated, there is consensus that the highest-risk individuals derive the greatest benefits [5]. Consistent with the evidence supporting the use of statins, the American College of Cardiology and American Heart Association’s (ACC/AHA) updated pr
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