The Complex Interplay Between Dyslipidemic Subjects Living with Type 2 Diabetes and Metabolic Syndrome and Statin Treatment: A Reflection on Adherence and Persistence in the Real World

INTRODUCTION: High levels of blood cholesterol are a major risk factor for atherosclerotic cardiovascular disease and require early and consistent utilization of statins as first-line medications to avoid disabling or even deadly consequences. Nevertheless, real-world treatment adherence is significantly lower than that reported in clinical trials. The present paper aims to improve understanding of the reasons behind this phenomenon to help physicians reduce morbidity, mortality, and healthcare costs by reversing this trend. METHODS: We conducted a real-life, observational, noninterventional, retrospective, multicenter study of statin prescription, adherence, persistence, potential side effects, and the rate of early discontinuation in 1959 individuals with type 2 diabetes mellitus (T2D), metabolic syndrome (MS), and moderate hypercholesterolemia, free of prior cardiovascular events in the observation period 2023-2025. In greater detail, we assessed three main areas: the history and features of the underlying pathology-understood as the "clinical condition"-the knowledge and beliefs, and the socioeconomic status of the patients by analyzing anonymized clinical records from the databases routinely used in our joint network units. RESULTS: Determinants significantly associated with insufficient or no adherence in the first area included older age, complex therapy involving multiple medications, and a history of myalgias and joint pain. In the second area, significant factors were low education, income levels, widowed/divorced, retired/unemployed conditions, and living alone. Finally, in the third area, a lack of awareness regarding cardiovascular disease (CVD) risk, previous negative experiences with statins, negative influence from social media, fear of side effects, a general rejection of medications, and a preference for "natural supplements," along with the belief that diet is sufficient and that therapy is of short duration, were identified. CONCLUSIONS: Our results prompted the decision to follow up with a prospective phase in which as many subjects as possible from this cohort will be contacted and interviewed to verify the consistency of the observations and to explore adherence further.