Physicians' Academy for Cardiovascular Education

Majority of statin-eligible US adults not taking a statin were never offered the therapy

Patient-Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry

Literature - Bradley CK, Wang TY, Li S et al. - J Am Heart Assoc. 2019;8

Introduction and methods

The 2013 ACC/AHA Guidelines broadened the statin recommendation, such that over 12 million high-risk adults in the United States were newly eligible for treatment with statins for primary CV prevention [1]. A large gap between guideline recommendations and actual clinical practice of statin use for both primary and secondary prevention has been described, even among the highest risk patients [2-4].

Statin underutilization results both from failure of clinicians to identify eligible patients and offer them statin therapy, and from patient refusal of the therapy when offered, or discontinuation by some patients. Understanding the reasons of each of these aspects can inform interventions to improve both primary and secondary ASCVD prevention.

This study is an analysis of the PALM (Patient and Provider Assessment of Lipid Management) registry, which aims to evaluate patient-reported reasons for not using statins (including not being offered the therapy, patient refusal and discontinuation of prior treatment), and differences in beliefs regarding safety and efficacy of statin therapy and perceived risk of ASCVD between current statin users and those were never offered, declined or discontinued treatment.

The PALM registry was a cross-sectional registry that enrolled 7938 patients from 140 cardiology, primary care, and endocrinology practices, who were potentially eligible for statin therapy. Information on statin use and beliefs regarding statin efficacy and safety were collected with surveys at baseline. Core lab lipid panels were also measured at baseline. Among those with survey and lab data, 5693 participants were eligible to start statins based on the 2013 ACC/AHA guidelines, 3184 because of prior ASCVD and 2509 had an indication for primary prevention statin use, based on their risk profile (mean age: 66 and 70 years, respectively).

Main results


This study showed demonstrates a large gap between recommendations of statin use and actual use. 27% Of adults who were eligible for statin therapy, did not receive the treatment. In almost 60%, this was because they were never offered a statin by their physician. A third of patients not using a statin, had done so before, but discontinued, and 10% declined use. In these groups, fear of side effects and perceived side effects were the most commonly reported reasons for not taking statins.


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