Abstract
Background Statins are medications that lower LDL-cholesterol levels. Discovered in 1971. Statins work by inhabiting Hydroxymethylglutaryl-CoA (HMG-CoA) reductase, which is an enzyme that catalyses the reduction of HMG-CoA to mevalonate. Inhibition of this enzyme decreases cholesterol synthesis, leading to upregulation of LDL receptors in the liver. This increases LDL uptake by hepatocytes, which causes a decrease of LDL levels in the blood. The use of statins has several indications. Based on the American College of Cardiology/American Heart Association 2018 guidelines, the use of statins for dyslipidemia is recommended as a primary and secondary prevention of ASCVD (Atherosclerotic Cardiovascular Disease). Other FDA approved indications of statin use are stroke and myocardial infarction prophylaxis. Purpose The purpose of this review is to illustrate the factors affecting statin adherence, reasons of non adherence, and the potential interventions to improve adherence to these medications. Methods A PubMed search was used, with statin and adherence as keywords. Studies reporting factors affecting adherence to stains, reasons for non-adherence to them and interventions to improve adherence to statind were included in the review. Results Two articles illustrated the factors affecting adherence and one article listed reasons for non-adherence. Six studies suggested possible interventions to improve adherence. Conclusions Many factors may affect the adherence to statin in a positive or negative way. Full insurance coverage, Frequent follow up and lipid testing showed a positive impact on adherence. By knowing this, better counseling and planning upon staring therapy is advised. Frequent counseling sessions by pharmacist or physician may improve adherence to statins. Comprehensive information given to statins users increases their adherence and the success of reaching the target LDL levels. Interventions such as cardiovascular risk counseling, educational pamphlet, adherence report or reminders mailed to the patients during therapy period may also increase adherence rate.