Nonacceptance of Statin Therapy Associated with Higher LDL-C Levels


Nonacceptance of statin therapy was prevalent among women and could contribute to known sex disparities in the treatment of high cholesterol.

Alexander Turchin, MD, MS

Credit: Brigham and Women's Hospital

Alexander Turchin, MD, MS

Credit: Brigham and Women's Hospital

Patients at high cardiovascular risk who did not accept statin therapy recommended by their healthcare professional were less likely to achieve low-density lipoprotein cholesterol (LDL-C) control within 1 year, according to new research.1

The retrospective findings suggest nonacceptance was common among patients at high cardiovascular risk and women had lower rates of statin acceptance than men, potentially contributing to known sex disparities in high cholesterol treatment.

“These are vulnerable individuals for whom evidence-based cholesterol-lowering therapy could significantly lower the incidence of cardiovascular events and related morbidity and mortality,” wrote the investigative team led by Alexander Turchin, MD, MS, Division of Endocrinology, Brigham and Women’s Hospital. “Therefore, the findings of this study have significant implications for public health as we continue to strive to decrease the risks of atherosclerotic cardiovascular disease (ASCVD) —the number one cause of death in the US and worldwide.”

Data on the nonacceptance of clinicians’ treatment recommendations by patients are lacking, as the information is not typically reflected in an electronic health record (EHR). However, the current study utilized natural language processing tools to investigate patient care processes documented in narrative documents. With this technology, investigators at Mass General Brigham evaluated sex disparities in the nonacceptance of statin therapy and assessed its relationship with LDL-C control.

Investigators conducted a retrospective cohort study from January 2019 to December 2022 among statin-naive patients with ASCVD, diabetes, or LDL-C levels of 190 mg/dL or more, treated between January 2000 and December 2018. A participant was entered into the study on the first date that statin therapy was recommended by a healthcare professional.

Acceptance or nonacceptance of a statin therapy recommended by the healthcare professional was identified as the primary independent variable, ascertained from the combination of electronic health record prescription data and natural language processing of electronic clinicians' notes. The primary outcome of the study was the time to LDL-C control of less than 100 mg/dL.

After exclusions, the study population consisted of 24,212 patients (mean age, 58.8 years; 12,294 women [50.8%]). Among this population, 5308 (21.9%) initially did not accept statin therapy and 1457 (6.0%) never initiated a statin during the follow-up period.

Data showed nonacceptance of statin therapy was more common among women than men(24.1% [2957 of 12 294] vs 19.7% [2351 of 11 918]; P < .001). Investigators observed similar findings in every subgroup in the analysis stratified by comorbidities.

Multivariable analysis adjusted for demographic characteristics and comorbidities revealed nonacceptance of statin therapy was associated with a longer time to achieve LDL-C control (hazard ratio [HR], 0.57 [95% CI, 0.55 - 0.60]; P < .001)

Women were additionally less likely to agree to take a statin when first recommended by a clinician (odds ratio [OR], 0.82 [95% CI, 0.78 - 0.88]). Patients who did accept a statin therapy recommendation achieved an LDL-C level of less than 100 mg/dL over a median of 1.5 years, compared to 4.4 years for those who did not accept a recommendation (P <.001).

“Further research is needed to identify the reasons why patients do not accept statin therapy recommendations and the reasons for the higher rates of this important clinical phenomenon among women,” investigators wrote.


  1. Brown CJ, Chang L, Hosomura N, et al. Assessment of Sex Disparities in Nonacceptance of Statin Therapy and Low-Density Lipoprotein Cholesterol Levels Among Patients at High Cardiovascular Risk. JAMA Netw Open. 2023;6(2):e231047. doi:10.1001/jamanetworkopen.2023.1047
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