Patient‐Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry
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Background: Many adults eligible for statin therapy for cardiovascular disease prevention are untreated. Our objective was to investigate patient‐reported reasons for statin underutilization, including noninitiation, refusal, and discontinuation. Methods and Results: This study included the 5693 adults recommended for statin therapy in the PALM (Patient and Provider Assessment of Lipid Management) registry. Patient surveys evaluated statin experience, reasons for declining or discontinuing statins, and beliefs about statins and cardiovascular disease risk. Overall, 1511 of 5693 adults (26.5%) were not on treatment. Of those not on a statin, 894 (59.2%) reported never being offered a statin, 153 (10.1%) declined a statin, and 464 (30.7%) had discontinued therapy. Women (relative risk: 1.22), black adults (relative risk: 1.48), and those without insurance (relative risk: 1.38) were most likely to report never being offered a statin. Fear of side effects and perceived side effects were the most common reasons cited for declining or discontinuing a statin. Compared with statin users, those who declined or discontinued statins were less likely to believe statins are safe (70.4% of current users vs. 36.9% of those who declined and 37.4% of those who discontinued) or effective (86.3%, 67.4%, and 69.1%, respectively). Willingness to take a statin was high; 67.7% of those never offered and 59.7% of patients who discontinued a statin would consider initiating or retrying a statin. Conclusions: More than half of patients eligible for statin therapy but not on treatment reported never being offered one by their doctor. Concern about side effects was the leading reason for statin refusal or discontinuation. Many patients were willing to reconsider statin therapy if offered.
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In a registry that studied reasons why eligible patients were not taking a statin, 59% reported never being offered treatment, 10% declined a statin, and 31% discontinued therapy.
“In a registry that studied reasons why eligible patients were not taking a statin, 59% reported never being offered treatment, 10% declined a statin, and 31% discontinued therapy.18”
From Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients (2023) · cites this paper as [18]
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- Authors
- Bradley, C. K., Wang, T. Y., Li, S., Robinson, J. G., Roger, V. L., Goldberg, A. C., Virani, S. S., Louie, M. J., Lee, L. V., Peterson, E. D., & Navar, A. M.
- Affiliations
- Duke University (US)
- University of Iowa (US)
- Mayo Clinic (US)
- Washington University in St. Louis (US)
- Baylor College of Medicine (US)
- Regeneron (United States) (US)
- Sanofi (United States) (US)
- Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NC
- Corresponding author
- Bradley, Corey K.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2019-04-02
- Volume
- 8
- Issue
- 7
- Pages
- e011765-e011765
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC6509731
- OpenAlex
- W2923928888
- Cited by
- 286
- References
- 25
- Citations by year
- 2026: 34 · 2025: 41 · 2024: 56 · 2023: 43 · 2022: 30 · 2021: 41 · 2020: 28 · 2019: 13
- FWCI
- 26.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by)
- eCommons - AKU (Aga Khan University) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K01HL133416)
- Duke Clinical Research Institute
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- statin therapy, statin discontinuation, fear of side effects, cardiovascular disease prevention, lipid control, health beliefs, racial and ethnic disparities, insurance status
- MeSH terms
- Patient Reported Outcome Measures, Adult, Aged, Attitude to Health, Black or African American, Cardiovascular Diseases, Fear, Female, Humans, Male, Middle Aged, Motivation, Practice Patterns, Physicians', Primary Prevention, Registries, Sex Factors, United States, Treatment Refusal, Hydroxymethylglutaryl-CoA Reductase Inhibitors, White People, Atherosclerosis, Healthcare Disparities, Medication Adherence, Secondary Prevention, Drug-Related Side Effects and Adverse Reactions
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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