Delayed Statin Initiation Following Detection of High LDL-C Raises Risk of Heart Attack

The delayed initiation of statin therapy following the incidental detection of high low-density lipoprotein cholesterol (LDL-C) in general health screenings is associated with a progressively higher risk of myocardial infarction (MI, heart attack), with the association more pronounced in younger individuals, males, or those without baseline diabetes, according to the results of a retrospective study published in European Heart Journal.¹

Importance of Statin Adherence

Individuals with high cardiovascular risk often struggle to achieve their LDL-C goals despite the wide use of lipid-lowering therapies like statins. LDL-C is a paramount target for reducing cardiovascular risk, as the retention of arterial lipoprotein promotes atherosclerosis. Unfortunately, some patients experience statin-associated adverse effects, including statin intolerance, or are facilitated misinformation related to statin therapy. Many patients with statin intolerance or statin-associated muscle symptoms may turn to self-medication, despite such strategies not being linked to lower LDL-C.^2-4

Timing statin administration is critical for effective LDL-C lowering. Despite the treatment being a standard of care for lowering lipid levels and reducing the risk of cardiovascular events, they remain underutilized—and often discontinued. Poor adherence to statins significantly impacts their efficacy, as they must be taken according to dosage and prescription consistently. One analysis revealed that when patients adhere to statins at a rate of 80%, there was a notable 6% decrease in cardiovascular risk.^1,5

For dyslipidemia that is incidentally found in general health check-ups, statin adherence can be especially difficult, especially if a patient does not present with established cardiovascular risk. Patients may resist beginning statin treatment for incidental dyslipidemia, and may require thorough counseling and education—which may still not be enough to ensure adherence and lower the risk of MI. The current investigation examined the association between statin initiation timing and the risk of MI in patients with high LDL-C discovered at an incidental checkup.¹

Delayed Statin Initiation Raises Risk of Heart Attack

Individuals aged 20 or older who underwent annual health checkups from 2009 to 2012 were included. The cohort was organized according to statin initiation timing, utilizing progressively delayed initiation intervals following detection of elevated LDL-C. The authors sought primarily to evaluate incident MI, while Cox proportional hazard models were utilized to estimate risk of MI for each treatment group compared with the normolipemic group.¹

A total of 5058 events of MI were identified across a median follow-up of 10.4 years among 508,284 individuals included in the study. The authors found that a more delayed statin initiation time was associated with a heightened risk of MI. The third year treatment group showed the highest risk compared with the normolipemic group (hazard ratio [HR]: 1.61 [95% CI, 1.37—1.89]; P < .001).¹

Furthermore, the significant increasing trend in MI risk with progressively delayed statin initiation was consistent across stratified and sensitivity analyses. Interestingly, the association was most pronounced among individuals of young age, male, or those without baseline diabetes. This is notable because individuals who present with risk factors, such as older age or diabetes comorbidity, often are at one of the highest cardiovascular risks and may need less counseling to initiate statin therapy. The lack of known risk in younger, non-diabetes patients may correlate to less of an inclination to initiate statins.¹

More research is necessary to elucidate the reasoning behind younger and non-diabetic individuals not initiating statins when dyslipidemia is discovered. However, as trusted health care providers, pharmacists stand to play an essential role in educating and counseling patients on the benefits of statin initiation. If a patient expresses concern or unwillingness to initiate statin therapy, a pharmacist is critical in explaining their heightened risk of MI and other cardiovascular events, while describing the ease and simplicity of statin therapy.¹

REFERENCES

1. Lee J, Kang MW, Oh J, et al. Association Between Delayed Statin Initiation After High LDL-Cholesterol Detection and Cardiovascular Risk in General Health Screening Examinees. Eur Heart J Qual Care Clin Outcomes. 2025:qcaf105. doi:10.1093/ehjqcco/qcaf105

2. Halpern L. Individuals With Very High Cardiovascular Risk Struggle to Attain LDL-C Goals. Pharmacy Times. Published September 3, 2025. Accessed September 19, 2025. https://www.pharmacytimes.com/view/individuals-with-very-high-cardiovascular-risk-struggle-to-attain-ldl-c-goals

3. Halpern L. Many Patients With Statin Intolerance Self-Medicate, Despite No Link to Lowering LDL-C. Pharmacy Times. Published August 29, 2025. Accessed September 19, 2025. https://www.pharmacytimes.com/view/many-patients-with-statin-intolerance-self-medicate-despite-no-link-to-lowering-ldl-c

4. Banach M, Penson PE. Adherence to statin therapy: it seems we know everything, yet we do nothing. Eur Heart J. 2022;2(6):oeac071. doi:10.1093/ehjopen/oeac071

5. Llanes EJ, Thongtang N, Lee Z, et al. Addressing adherence challenges in long-term statin treatment among Asian populations: Current gaps and proposed solutions. Am J Prev Cardiol. 2025;23:101019. doi:10.1016/j.ajpc.2025.101019