Systematic Review of Patient Attitudes Towards Statins and how they Relate to Statin Intolerance

Abstract

Objective: Adherence to statins is poor despite evidence of their safety and effectiveness, potentially complicated by statin intolerance. The reasons for statin intolerance are debated; however patient attitudes and beliefs towards statins is an important factor. We conducted a systematic review of the literature exploring the relationship of patient attitudes and beliefs towards statins to statin non-adherence and intolerance. Methods: Search of three (EMBASE, Medline and PsycINFO) databases for the last 20 years up to March 2019 revealed 28 studies encompassing 31,525 patients. Results: Mean age was 61.9 ± 4.4 years. Two studies investigated primary prevention, four investigated secondary, while the rest included both. Three studies used open-ended qualitative discussions while the rest used structured quantitative questionnaires, 75% of which tailored their own study-specific questionnaires while the Beliefs about Medicine Questionnaire was the most commonly used standardised questionnaire. Among non-adherers, the most common attitudes and beliefs included lack of perceived benefit, lack of perceived cardiovascular risks, fear of side effects, poor knowledge, disliking medication, and being negatively influenced by media. Statin intolerance was the most common reason for intentional non-adherence. All but one study found that negative health beliefs are associated with non-adherence. None examined the direct relationship between attitudes and beliefs and statin intolerance. Conclusion: There is consensus in the literature that attitudes and beliefs regarding statins can predict non-adherence and that statin intolerance is the most common reason for intentional non-adherence. Further research is needed regarding the relationship between attitudes and beliefs and statin intolerance.