{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:17:56Z","timestamp":1787721476212,"version":"build-2784847793"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010438","name":"Poznan University of Medical Sciences","doi-asserted-by":"crossref","award":["JAK0000049"],"award-info":[{"award-number":["JAK0000049"]}],"id":[{"id":"10.13039\/501100010438","id-type":"DOI","asserted-by":"crossref"}]},{"award":["JAK0000049"],"award-info":[{"award-number":["JAK0000049"]}],"id":[{"id":"https:\/\/ror.org\/02zbb2597","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Background: Statins are among the most frequently prescribed medications worldwide, with proven benefits in reducing all-cause and cardiovascular mortality, preventing major adverse cardiovascular events (MACEs), and lowering healthcare costs. Despite their well-established safety and effectiveness, discontinuation of statin therapy remains a common problem in both primary and secondary prevention. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines and registered in the PROSPERO database (CRD420261295172). Original studies published since 1 January 2014 were identified through searches of PubMed (MEDLINE) and Google Scholar using predefined keywords. Methodological quality and risk of bias of the included observational studies were evaluated using the Newcastle-\u2013Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Synthesized data from 29 included studies indicate that up to half of patients discontinue statin therapy within the first year (discontinuation rates ranging from 27.1% to 47.0% in primary prevention and 18.5% to 32.4% in secondary prevention), with rates increasing over time. Major factors contributing to non-adherence include fear of side effects, particularly statin-associated muscle symptoms (SAMSs), misinformation, limited patient\u2013physician communication, socioeconomic barriers, and polypharmacy. Discontinuation is associated with significantly higher all-cause and cardiovascular mortality (Hazard Ratios ranging from 1.30 to 4.65), higher rates of cardiovascular and cerebrovascular events, worsening metabolic outcomes, reduced quality of life, and greater healthcare expenditures. Conclusions: Improving adherence requires better patient education, addressing misconceptions, strengthening patient\u2013physician relationships, and optimising treatment regimens. A multidisciplinary approach is needed to prevent unjustified discontinuation and improve long-term clinical outcomes.<\/jats:p>","DOI":"10.3390\/metabo16090603","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:19Z","timestamp":1787572039000},"page":"603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Statin Paradox: Drivers and Consequences of Therapy Discontinuation"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9931-4699","authenticated-orcid":false,"given":"Adrianna","family":"Dylik","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Pozna\u0144, Poland"},{"name":"Student Scientific Association of Lifestyle Medicine, The Student Scientific Society, Pozna\u0144 University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3113-8677","authenticated-orcid":false,"given":"Miko\u0142aj","family":"Musia\u0142","sequence":"additional","affiliation":[{"name":"Student Scientific Association of Lifestyle Medicine, The Student Scientific Society, Pozna\u0144 University of Medical Sciences, 61-701 Pozna\u0144, Poland"},{"name":"Day Psychiatric Rehabilitation Unit for Children and Adolescents, Institute of Psychoeducation Ltd., Bystra St. 7, Nowe Miasto, 61-366 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4729-5455","authenticated-orcid":false,"given":"Micha\u0142","family":"Radke","sequence":"additional","affiliation":[{"name":"Student Scientific Association of Lifestyle Medicine, The Student Scientific Society, Pozna\u0144 University of Medical Sciences, 61-701 Pozna\u0144, Poland"},{"name":"\u015aroda Hospital of the Sacred Heart of Jesus, 63-000 \u015aroda Wielkopolska, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Tuzimek","sequence":"additional","affiliation":[{"name":"Student Scientific Association of Lifestyle Medicine, The Student Scientific Society, Pozna\u0144 University of Medical Sciences, 61-701 Pozna\u0144, Poland"},{"name":"Polish Red Cross Maritime Hospital, Powstania Styczniowego Street 1, 81-519 Gdynia, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2687-4478","authenticated-orcid":false,"given":"Dominika","family":"Rogo\u017ca","sequence":"additional","affiliation":[{"name":"Student Scientific Association of Lifestyle Medicine, The Student Scientific Society, Pozna\u0144 University of Medical Sciences, 61-701 Pozna\u0144, Poland"},{"name":"Multi-Specialty Independent Public Healthcare Complex in Nowa S\u00f3l, 7 Cha\u0142ubi\u0144skiego Street, 67-100 Nowa S\u00f3l, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1850-3195","authenticated-orcid":false,"given":"Bartosz","family":"Czeka\u0142a","sequence":"additional","affiliation":[{"name":"Student Scientific Association of Lifestyle Medicine, The Student Scientific Society, Pozna\u0144 University of Medical Sciences, 61-701 Pozna\u0144, Poland"},{"name":"Multi-Specialty Independent Public Healthcare Complex in Nowa S\u00f3l, 7 Cha\u0142ubi\u0144skiego Street, 67-100 Nowa S\u00f3l, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Wawrzyniak","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadzeya","family":"Zhuk","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4173-5965","authenticated-orcid":false,"given":"Katarzyna","family":"Skrypnik","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition and Dietetics, Pozna\u0144 University of Life Sciences, Wojska Polskiego Street 28, 60-637 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5643-6899","authenticated-orcid":false,"given":"Damian","family":"Skrypnik","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Feng, C., Wang, Y., Xu, J., Zheng, Y., Zhou, W., Wang, Y., and Luo, C. (2024). Precisely Tailoring Molecular Structure of Doxorubicin Prodrugs to Enable Stable Nanoassembly, Rapid Activation, and Potent Antitumor Effect. Pharmaceutics, 16.","DOI":"10.3390\/pharmaceutics16121582"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1038\/s41401-024-01305-9","article-title":"A Novel Small-Molecule PCSK9 Inhibitor E28362 Ameliorates Hyperlipidemia and Atherosclerosis","volume":"45","author":"Wang","year":"2024","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.jsps.2023.04.002","article-title":"Statins Utilization Trends and Expenditures in the U.S. before and after the Implementation of the 2013 ACC\/AHA Guidelines","volume":"31","author":"Matyori","year":"2023","journal-title":"Saudi Pharm. J. SPJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.atherosclerosis.2021.05.016","article-title":"Trends in Lipid-Modifying Agent Use in 83 Countries","volume":"328","author":"Blais","year":"2021","journal-title":"Atherosclerosis"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2113186","DOI":"10.1001\/jamanetworkopen.2021.13186","article-title":"Cardiovascular Outcomes and Mortality Associated With Discontinuing Statins in Older Patients Receiving Polypharmacy","volume":"4","author":"Rea","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2136802","DOI":"10.1001\/jamanetworkopen.2021.36802","article-title":"Statin Discontinuation and Cardiovascular Events Among Older People in Denmark","volume":"4","author":"Thompson","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3516","DOI":"10.1093\/eurheartj\/ehz458","article-title":"Cardiovascular Effect of Discontinuing Statins for Primary Prevention at the Age of 75 Years: A Nationwide Population-Based Cohort Study in France","volume":"40","author":"Giral","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_8","first-page":"2317","article-title":"The Influence of Statin Withdrawal and Adherence on Stroke Outcomes","volume":"42","author":"Vitturi","year":"2021","journal-title":"Neurol. Sci. Off. J. Ital. Neurol. Soc. Ital. Soc. Clin. Neurophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"717","DOI":"10.2147\/PPA.S245324","article-title":"Long-Term Benefit and Withdrawal Effect of Statins After Percutaneous Coronary Intervention: A Nationwide Population-Based Cohort Study","volume":"14","author":"Jeong","year":"2020","journal-title":"Patient Prefer. Adherence"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e779","DOI":"10.1097\/MD.0000000000000779","article-title":"Statin Withdrawal beyond Acute Phase Affected Outcome of Thrombolytic Stroke Patients: An Observational Retrospective Study","volume":"94","author":"Tong","year":"2015","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"107469","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107469","article-title":"Effectiveness of Statins on Outcomes of Patients with Embolic Stroke of Undetermined Source (ESUS)","volume":"33","author":"Vitturi","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis. Off. J. Natl. Stroke Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1161\/STROKEAHA.122.040536","article-title":"Lack of Statin Therapy and Outcomes After Ischemic Stroke: A Population-Based Study","volume":"54","author":"Ruuskanen","year":"2023","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.amjcard.2014.09.039","article-title":"Impact of Postdischarge Statin Withdrawal on Long-Term Outcomes in Patients with Acute Myocardial Infarction","volume":"115","author":"Kim","year":"2015","journal-title":"Am. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.jacl.2023.08.002","article-title":"Admission LDL-Cholesterol, Statin Pretreatment and Early Outcomes in Acute Ischemic Stroke","volume":"17","author":"Kim","year":"2023","journal-title":"J. Clin. Lipidol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100887","DOI":"10.1016\/j.lanepe.2024.100887","article-title":"Lifetime Effects and Cost-Effectiveness of Standard and Higher-Intensity Statin Therapy across Population Categories in the UK: A Microsimulation Modelling Study","volume":"40","author":"Mihaylova","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"i3305","DOI":"10.1136\/bmj.i3305","article-title":"Discontinuation and Restarting in Patients on Statin Treatment: Prospective Open Cohort Study Using a Primary Care Database","volume":"353","author":"Vinogradova","year":"2016","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.amjcard.2023.09.047","article-title":"Statin Discontinuation After Coronary Revascularization","volume":"207","author":"Yamamoto","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1007\/s11096-015-0147-7","article-title":"Older Peoples\u2019 Attitudes Regarding Polypharmacy, Statin Use and Willingness to Have Statins Deprescribed in Australia","volume":"37","author":"Qi","year":"2015","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"123","DOI":"10.3122\/jabfm.2021.01.200262","article-title":"Perceptions of Patients with Primary Nonadherence to Statin Medications","volume":"34","author":"Tarn","year":"2021","journal-title":"J. Am. Board Fam. Med. JABFM"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e70628","DOI":"10.1111\/cns.70628","article-title":"Lymphoplasmapheresis for Steroid-Refractory Neuromyelitis Optica Spectrum Disorder: A Real-World Multicenter Study in China","volume":"31","author":"Zeng","year":"2025","journal-title":"CNS Neurosci. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e71079","DOI":"10.1096\/fj.202501761R","article-title":"MIF Promotes Phenotypic Switching of VSMCs via AKT\/mTOR-Mediated Autophagy Regulation in Aortic Dissection","volume":"39","author":"Pu","year":"2025","journal-title":"FASEB J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.jacl.2016.04.010","article-title":"Predictors of First-Year Statin Medication Discontinuation: A Cohort Study","volume":"10","author":"Halava","year":"2016","journal-title":"J. Clin. Lipidol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wouters, H., Dijk, L.V., Geers, H.C.J., Winters, N.A., Geffen, E.C.G.V., Stiggelbout, A.M., and Bouvy, M.L. (2016). Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0146272"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1093\/eurheartj\/ehv641","article-title":"Negative Statin-Related News Stories Decrease Statin Persistence and Increase Myocardial Infarction and Cardiovascular Mortality: A Nationwide Prospective Cohort Study","volume":"37","author":"Nielsen","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/j.amjcard.2014.07.010","article-title":"Comparison of the Risk of Psychological and Cognitive Disorders Between Persistent and Nonpersistent Statin Users","volume":"114","author":"Lilly","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"441","DOI":"10.11124\/JBIES-24-00103","article-title":"The revised JBI critical appraisal tool for the assessment of risk of bias for cohort studies","volume":"23","author":"Barker","year":"2025","journal-title":"JBI Evid. Synth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"401","DOI":"10.11124\/JBIES-24-00523","article-title":"The Revised JBI Critical Appraisal Tool for the Assessment of Risk of Bias for Analytical Cross-Sectional Studies","volume":"24","author":"Barker","year":"2026","journal-title":"JBI Evid. Synth."},{"key":"ref_28","unstructured":"Martin, J. (2026, August 03). \u00a9 Joanna Briggs Institute 2017 Critical Appraisal Checklist for Qualitative Research. Available online: https:\/\/jbi.global\/sites\/default\/files\/2021-10\/Checklist_for_Qualitative_Research.docx."},{"key":"ref_29","unstructured":"Newcastle-Ottawa Scale (NOS), and Ottawa Hospital Research Institute (2026, August 03). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Available online: https:\/\/ohri.ca\/en\/who-we-are\/core-facilities-and-platforms\/ottawa-methods-centre\/newcastle-ottawa-scale."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e003626","DOI":"10.1161\/CIRCOUTCOMES.117.003626","article-title":"Statin Discontinuation, Reinitiation, and Persistence Patterns Among Medicare Beneficiaries After Myocardial Infarction","volume":"10","author":"Booth","year":"2017","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_31","first-page":"377","article-title":"Frequent General Practitioner Visits Are Protective against Statin Discontinuation after a Pharmaceutical Benefits Scheme Copayment Increase","volume":"44","author":"Seaman","year":"2020","journal-title":"Aust. Health Rev. Publ. Aust. Hosp. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e007106","DOI":"10.1161\/JAHA.117.007106","article-title":"Changes in Statin Adherence Following an Acute Myocardial Infarction Among Older Adults: Patient Predictors and the Association with Follow-Up with Primary Care Providers and\/or Cardiologists","volume":"6","author":"Hickson","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/14740338.2018.1458837","article-title":"Preventable Statin Adverse Reactions and Therapy Discontinuation. What Can We Learn from the Spontaneous Reporting System?","volume":"17","author":"Sessa","year":"2018","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3407","DOI":"10.1007\/s12325-024-02916-8","article-title":"Differential Adherence to Free and Single-Pill Combination of Rosuvastatin\/Ezetimibe: Findings from a Real-World Analysis in Italy","volume":"41","author":"Liberopoulos","year":"2024","journal-title":"Adv. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1093\/fampra\/cmac090","article-title":"Factors Associated with Statin Discontinuation near End of Life in a Danish Primary Health Care Cohort","volume":"40","author":"Engell","year":"2023","journal-title":"Fam. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1002\/clc.22975","article-title":"Understanding Patient Adherence and Concerns with STatins and MedicatION Discussions With Physicians (ACTION): A Survey on the Patient Perspective of Dialogue with Healthcare Providers Regarding Statin Therapy","volume":"41","author":"Brinton","year":"2018","journal-title":"Clin. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1089\/jpm.2016.0489","article-title":"Perceptions of Statin Discontinuation among Patients with Life-Limiting Illness","volume":"20","author":"Tjia","year":"2017","journal-title":"J. Palliat. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2147\/PPA.S432448","article-title":"Older Adult Perspectives on Statin Continuation and Discontinuation in Primary Cardiovascular Disease Prevention: A Mixed-Methods Study","volume":"18","author":"Brunner","year":"2024","journal-title":"Patient Prefer. Adherence"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.atherosclerosis.2015.12.015","article-title":"Identification and Management of Patients with Statin-Associated Symptoms in Clinical Practice: A Clinician Survey","volume":"245","author":"Hovingh","year":"2016","journal-title":"Atherosclerosis"},{"key":"ref_40","first-page":"53","article-title":"Patient Characteristics and Statin Discontinuation-Related Factors during Treatment of Hypercholesterolemia: An Observational Non-Interventional Study in Patients with Statin Discontinuation (STAY Study)","volume":"44","author":"Ceyhan","year":"2016","journal-title":"Turk Kardiyol. Dern. Ars."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"10-24926","DOI":"10.24926\/iip.v10i2.1958","article-title":"Assessment of Patient Education about Statin Therapy on Quality Measures and Knowledge in an Independent Community Pharmacy","volume":"10","author":"Clark","year":"2019","journal-title":"Innov. Pharm."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s10557-017-6738-x","article-title":"Primary Care Physician Perspectives on Barriers to Statin Treatment","volume":"31","author":"Tanner","year":"2017","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s41999-021-00479-3","article-title":"Polypharmacy in Older Adults: A Narrative Review of Definitions, Epidemiology and Consequences","volume":"12","author":"Pazan","year":"2021","journal-title":"Eur. Geriatr. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"n1537","DOI":"10.1136\/bmj.n1537","article-title":"Associations between Statins and Adverse Events in Primary Prevention of Cardiovascular Disease: Systematic Review with Pairwise, Network, and Dose-Response Meta-Analyses","volume":"374","author":"Cai","year":"2021","journal-title":"BMJ"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Xu, H.-Y., Yu, Y.-J., Zhang, Q.-H., Hu, H.-Y., and Li, M. (2020). Tailored Interventions to Improve Medication Adherence for Cardiovascular Diseases. Front. Pharmacol., 11.","DOI":"10.3389\/fphar.2020.510339"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Li, H., Jia, X., Min, H., Zhang, Y., Wang, H., and Zhai, Y. (2023). Relationships between Beliefs about Statins and Non-Adherence in Inpatients from Northwestern China: A Cross-Sectional Survey. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1078215"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.tcm.2019.01.001","article-title":"Effect of Statins on Atherosclerotic Plaque","volume":"29","author":"Almeida","year":"2019","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.phrs.2014.03.002","article-title":"The Pharmacology of Statins","volume":"88","author":"Sirtori","year":"2014","journal-title":"Pharmacol. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12933-018-0703-2","article-title":"Diabetes, Cardiovascular Disease and the Microcirculation","volume":"17","author":"Strain","year":"2018","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.pcad.2023.04.008","article-title":"Exercise and Cardiovascular Health: A State-of-the-Art Review","volume":"79","author":"Isath","year":"2023","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"282","DOI":"10.5853\/jos.2015.17.3.282","article-title":"Statins in Acute Ischemic Stroke: A Systematic Review","volume":"17","author":"Hong","year":"2015","journal-title":"J. Stroke"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"675","DOI":"10.2147\/PPA.S245365","article-title":"Reasons for Nonadherence to Statins\u2014A Systematic Review of Reviews","volume":"14","author":"Ingersgaard","year":"2020","journal-title":"Patient Prefer. Adherence"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"6314","DOI":"10.2174\/1381612820666140620162629","article-title":"Statin Treatment Non-Adherence and Discontinuation: Clinical Implications and Potential Solutions","volume":"20","author":"Phan","year":"2014","journal-title":"Curr. Pharm. Des."}],"container-title":["Metabolites"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/9\/603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:18:06Z","timestamp":1787717886000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-1989\/16\/9\/603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":53,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["metabo16090603"],"URL":"https:\/\/doi.org\/10.3390\/metabo16090603","relation":{},"ISSN":["2218-1989"],"issn-type":[{"value":"2218-1989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]}}}