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J Am Heart Assoc. 2019 Apr 2;8(7):e011765. doi: 10.1161/JAHA.118.011765.

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

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1 Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NC.
2 Department of Epidemiology College of Public Health University of Iowa Iowa City IA.
3 Department of Internal Medicine Division of Cardiovascular Diseases Mayo Clinic Rochester MN.
4 Washington University St Louis MO.
5 Department of Medicine Baylor College of Medicine Houston TX.
6 Global Medical Affairs Regeneron Pharmaceuticals, Inc. Tarrytown NY.
7 Sanofi Pharmaceuticals Bridgewater NJ.


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.


cardiovascular disease prevention; patient education/teaching; statin therapy

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