Patient-Perceived Barriers to Statin Use and High-Intensity Statin Therapy

The PALM (Patient and Provider Assessment of Lipid Management) registry surveyed 7,614 patients across 138 U.S. primary care and cardiology practices to characterize patient-perceived barriers to statin use and high-intensity statin therapy.

Among statin-eligible patients not receiving statins, the most common barrier was provider non-prescription — not patient refusal. Among patients on statins, a substantial proportion were on lower-than-guideline-recommended intensity, with patients reporting side effect concerns, cost concerns, and uncertainty about personal benefit as the primary reasons for non-adherence or resistance to dose escalation.

Notably, side effect concerns were common among patients who had never tried statins — reflecting a nocebo effect driven by awareness of potential side effects rather than personal experience. Patients with ASCVD were more likely to receive high-intensity therapy than primary prevention patients, consistent with guideline-concordant prioritization but also reflecting undertreatment in primary prevention.

The PALM data frame the implementation gap: the largest opportunity to improve statin utilization is not drug development but patient communication, provider prescribing behavior, and healthcare access. For individual patients, the data support addressing anticipated rather than experienced side effects as a key barrier to overcome.

We rate the evidence moderate. A well-designed registry study providing real-world data on barriers to statin adherence — useful for contextualizing the gap between guidelines and practice.