Discontinuation of statin therapy – an updated review

Purpose of review

This narrative review aims to provide an updated synthesis of the recent epidemiology, clinical determinants, and consequences of statin discontinuation. Recent findings Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, with elevated low-density lipoprotein cholesterol (LDL-C) representing a key modifiable risk factor. Statins are first-line lipid-lowering agents that reduce major adverse cardiovascular events, cardiovascular mortality, and all-cause mortality. Despite their efficacy, statin discontinuation and suboptimal adherence remain common. Discontinuation rates within the first-year range widely (0.8%-70.5%), with higher rates observed in primary prevention populations. Factors associated with discontinuation include male sex, non-White ethnicity, smoking, and lack of insurance, whereas secondary prevention is consistently associated with better persistence. Interestingly, polypharmacy demonstrated conflicting associations across studies. Overall approximately 40% of patients fail to achieve optimal adherence. Discontinuation is consistently associated with increased cardiovascular events, hospitalizations, and all-cause mortality.

Summary

Statin discontinuation and poor adherence remain major barriers to effective cardiovascular risk reduction. Addressing patient, clinician, and system-level determinants is essential to improve long-term adherence and clinical outcomes.

Keywords

adherence, cardiovascular disease, statin discontinuation, statin therapy