Adherence to PCSK9i

The panelists discuss how adherence to lipid-lowering therapy, particularly after acute cardiovascular events, remains one of the most significant gaps in preventive cardiology. Despite the availability of effective treatments, real-world data consistently show that a large proportion of patients fail to stay on their prescribed medications over time. In studies from integrated health systems, only about 30% to 35% of patients maintain high adherence—measured as days covered over 80%—even in the first year following an event, when the risk of recurrence is highest.

The problem doesn’t stop after the first year. Even among those who initially stay on therapy, adherence sharply declines over the next several years. This long-term drop-off has profound consequences: Patients with low adherence face significantly higher rates of adverse cardiovascular outcomes compared with those who stay on therapy consistently. These patterns hold across different low-density lipoprotein (LDL)–lowering therapies, including statins and newer agents like PCSK9 inhibitors. The issue isn’t just clinical inertia or adverse effects; it’s also psychological, educational, and systemic.

Crucially, lipid-lowering therapy isn’t a short-term fix. It’s a long-term strategy to stabilize plaque, prevent progression, and reduce the likelihood of future events. The comparison to antibiotics is misleading; cholesterol management doesn’t yield immediate symptom relief, so the motivation to persist can wane, especially if patients do not feel unwell. Addressing adherence will require a multifaceted approach: simplifying regimens, improving education, leveraging longer-acting therapies such as inclisiran, and integrating systems-based support for follow-up and prescription renewals. Until we bridge the gap between prescription and persistence, the full promise of our therapeutic arsenal will remain unrealized.