Overcoming Challenges With Statin Therapy.

B ecause statins markedly reduce cardiovascular risk, poor persistence with them is an important clinical problem. If statins were stopped for valid reasons, there may be no opportunity for improvement. However, there are many invalid reasons why patients stop medication, often for symptoms that, although not causally related, are listed in package inserts. Physicians also stop statin therapy for invalid reasons. Several consensus statements, from the Canadian Cardiology Society, the European Atherosclerosis Society, and the National Lipid Association, have reviewed aspects of the adverse effects of statins from various perspectives. In this narrative review, we discuss approaches to helping patients continue needed therapy with statins, based on experience with >50 000 patients attending our vascular prevention clinics over many years and from the perspective of clinical pharmacology, including pharmacokinetic and pharmacogenomic factors that impair persistence by worsening causally related effects of statins.