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.