• Adherence;
  • cardiovascular disease;
  • hypercholesterolemia;
  • low-density lipoprotein cholesterol;
  • statins


To discuss the merits of statins in achieving lipid goals and the role of nurse practitioners (NPs) in improving adherence to medical regimens with the goals of improving patient outcomes, reducing cardiovascular disease (CVD) risk within the population at large, and enhancing patients’ ability to reach their individual goals.

Data sources

Original research articles, journal articles, professional association practice guidelines.


Despite extensive research clearly documenting the relation between lowering low-density lipoprotein cholesterol (LDL-C) and decreasing rates of cardiovascular events and deaths, lipid-lowering therapy is not being aggressively managed to achieve optimal lipid levels and CVDs remain the leading cause of death among adults in the United States. Contributing factors include lack of patient adherence with prescribed therapy, absence of dose titration when needed, and suboptimal follow-up. Two pathways to improving compliance are the following: first, use of a starting dose of a more efficacious statin to allow more patients to reach their LDL-C goal and, second, more effective primary care programs with NPs as team leaders who can assess and diagnose patients, then develop individual treatment plans and follow-up with patients to ensure that their lipid goals are met.

Implications for practice

NPs are well suited to manage patients with hypercholesterolemia. The NP can bridge all aspects of care for the patient by overseeing assessment and treatment of cardiovascular risk factors, including elevated levels of LDL-C, initiating pharmacotherapy when needed, and establishing for each patient an individualized program that features education, support, and follow-up.