• Derjung M Tarn, Maureen Barrientos, Mark J Pletcher, Keith Cox, Jon Turner, Alicia Fernandez, and Janice B Schwartz.
• From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California-San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California-Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California-San Francisco, San Francisco, CA (AF).
• J Am Board Fam Med. 2021 Jan 1; 34 (1): 123131123-131.

BackgroundDespite emphasis on efforts to prevent cardiovascular disease (CVD), 13% to 34% of people never fill a prescribed statin (primary nonadherence). This study determined perceptions of adults with primary nonadherence to statins.MethodsTen focus groups were conducted with 61 adults reporting primary nonadherence to statins (93% without known CVD). Participants were recruited from an academic medical center and nationwide Internet advertisements.ResultsMajor themes related to primary nonadherence were 1) desire to pursue alternatives before starting a statin (eg, diet and/or exercise, dietary supplements), 2) worry about risks and adverse effects of statins, 3) perceptions of good personal health (suggesting that a statin was not needed), and 4) doubt about the benefits of statins in the absence of disease. Additional themes included mistrust of the pharmaceutical industry, mistrust of prescribing providers, inadequate provider communication about statins, and negative prior experiences with medication. Although rare, a few patients said that high cholesterol does not require treatment if it is genetic. One third noted during focus group discussions that they did not communicate their decision not to take a statin to providers.ConclusionsAdults with primary nonadherence to statins describe seeking alternatives, avoiding perceived risks of statins, poor acceptance/understanding of CVD risk estimates, and doubts about the benefits of statins. Many do not disclose their decisions to providers, thus highlighting the need for provider awareness of the potential for primary nonadherence at the point of prescribing, and the need for future work to develop strategies to identify patients with potential primary nonadherence.© Copyright 2021 by the American Board of Family Medicine.

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