Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Int J Environ Res Public Health. 2023 May 19;20(10):5878. doi: 10.3390/ijerph20105878.
Poor adherence to chronic disease treatment may seriously compromise the effectiveness of therapy, characterizing itself as a critical element for the population's health, both from the point of view of quality of life and health economics. The causes of low adherence are many and can depend on the patient, the physician and the healthcare system. Low adherence to dietary recommendations and lipid-lowering drug therapy for hypercholesterolemia is a widespread phenomenon that may strongly limit the great advantages of serum lipid reduction strategies in primary and secondary cardiovascular prevention. Many patients discontinue treatment, and adherence decreases with time. Increasing therapeutic adherence can have a much greater impact on the health of the population than any other therapeutic advance. There are numerous strategies to increase therapy adherence according to behavior change theories. They concern the doctor and the patient. Some must be implemented at the time of prescription, others later during the follow-up. The active role of the patient in the therapeutic decision and the shared definition of LDL cholesterol targets are of paramount importance. The aim of this narrative review is to summarize evidence on current levels of adherence to lipid-lowering strategies, the causes of the lack of adequate adherence and possible physician-applicable strategies to improve it.
慢性病治疗的依从性差可能严重影响治疗效果，从生活质量和卫生经济学的角度来看，这是人群健康的一个关键因素。导致依从性差的原因有很多，可能取决于患者、医生和医疗保健系统。降胆固醇药物治疗和饮食建议的依从性低是一种普遍现象，可能会严重限制血脂降低策略在一级和二级心血管预防中的巨大优势。许多患者停止治疗，而且随着时间的推移，依从性会下降。提高治疗依从性对人群健康的影响可能比任何其他治疗进展都大。根据行为改变理论，有许多策略可以提高治疗依从性。这些策略涉及医生和患者。有些必须在开处方时实施，其他的则在随访期间实施。患者在治疗决策中的积极作用和 LDL 胆固醇目标的共同定义至关重要。本文的目的是总结目前降脂策略依从性的水平、缺乏充分依从性的原因以及可能适用于医生的提高依从性的策略。
