{
  "abstract": "Background Despite proven benefits, adherence to statin therapy remains suboptimal in primary prevention populations. This study hypothesized that incorporating patient autonomy into the decision-making process would improve statin compliance and reduce perceived side effects among initially reluctant patients.Methods We conducted a randomized trial involving 276 patients over age 40 without atherosclerotic cardiovascular disease (ASCVD) but at moderate ASCVD risk who initially declined statin therapy. Patients were block-randomized into control and intervention groups. The control group received standard reassurance and 30mg atorvastatin. The intervention group was offered a trial of red yeast rice extract 20mg with a goal LDL of 100 mg/dL (2.6 mmol/l); those not reaching goal after 2 months were prescribed 30mg atorvastatin. Primary endpoint was statin adherence at 6 months measured by pharmacy refills. Secondary endpoints included self-reported myalgias, fatigue, mental fog, and gastrointestinal upset.Results Baseline characteristics were similar between groups, including age (62±17 vs 61.5±20 years), weight (80±27 vs 80±28 kg), gender distribution (50.7% male in both), marital status (94.9% vs 91.3% married), lifestyle factors (smoking: 47.8% vs 49.3%), comorbidities (hypertension: 58% vs 56.5%; diabetes: 8.7% vs 11.6%), and comprehensive lipid profiles (total cholesterol: 217.9±86.4 vs 222.9±78.7 mg/dL; LDL-C: 147.3±76.7 vs 153.1±71.2 mg/dL; HDL-C: 44.3±21.3 vs 46.8±16.6 mg/dL; triglycerides: 101.4±85 vs 101.4±82.4 mg/dL). The intervention group demonstrated significantly higher median prescriptions filled ( figure 1). Patients in the intervention group reported lower rates of fatigue and mental fog, though rates of myalgias and gastrointestinal upset were similar between groups (figure 2).Conclusion Introducing patient autonomy in the statin decision-making process significantly improved adherence to atorvastatin therapy and reduced certain perceived side effects. This approach may represent an effective strategy for improving outcomes in statin-reluctant patients with moderate ASCVD.Abstract 9 Figure 1Number of atorvastatin scripts filled in patients on statin therapyAbstract 9 Figure 2Frequency of secondary outcomes in patients initiated on atorvastatin",
  "authors": [
    {
      "affiliations": [
        "University of Galway, Galway, Ireland",
        "Bon Secours Hospital Limerick, Limerick, Ireland",
        "Lithuanian University of Health Sciences, Kaunas, Lithuani"
      ],
      "name": "A Aldujeli"
    },
    {
      "affiliations": [
        "Houston Methodist Hospital, Houston, Texas, USA"
      ],
      "name": "A Haq"
    },
    {
      "affiliations": [
        "Lithuanian University of Health Sciences, Kaunas, Lithuani"
      ],
      "name": "D Zaliaduonyte"
    },
    {
      "affiliations": [
        "Lithuanian University of Health Sciences, Kaunas, Lithuani"
      ],
      "name": "V Tatarunas"
    },
    {
      "affiliations": [
        "Lithuanian University of Health Sciences, Kaunas, Lithuani"
      ],
      "name": "S Kmitaite"
    },
    {
      "affiliations": [
        "Lithuanian University of Health Sciences, Kaunas, Lithuani"
      ],
      "name": "E Meksraityte"
    },
    {
      "affiliations": [
        "St James’s Hospital, Dublin, Ireland"
      ],
      "name": "F Azani"
    },
    {
      "affiliations": [
        "Connolly Hospital Blanchardstown, Dublin, Ireland"
      ],
      "name": "S Rana"
    },
    {
      "affiliations": [
        "University of Limerick, Limerick, Ireland"
      ],
      "name": "T Kiernan"
    },
    {
      "affiliations": [
        "Minneapolis Heart Institute, Minneapolis, Minnesota, USA"
      ],
      "name": "M Miedema"
    }
  ],
  "title": "9 Evaluating the relationship between patient autonomy and statin adherence: results from the PASTA multicenter randomized clinical trial",
  "uid": "26b47b6c-5105-5f92-8cb5-9caa6bd403a4"
}