Question special

As Jarcho and Keaney noted in their accompanying editorial, a main factor limiting potential long term effectiveness is the discontinuation rate of 42% overall, or 7% yearly. What are the primary reasons for patients to discontinue their lipid-lowering therapy, and what can be done to maintain adherence to treatment in the long-term? Do you think long-term adherence might be better if ezetimibe were used in combination with a statin that is generally better tolerated (i.e., has less potential for drug interactions and adverse side effects, such as myopathy) than simvastatin?