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Comment & Response
April 28, 2021

Statin Prescribing and Dosing—Failure Has Become an Option—Reply

Author Affiliations
  • 1Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania
  • 2Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Office of the Chief Medical Information Officer, University of Pennsylvania Health System, Philadelphia
  • 4Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • 5The Wharton School, University of Pennsylvania, Philadelphia
JAMA Cardiol. 2021;6(7):855. doi:10.1001/jamacardio.2021.0838

In Reply We thank Mark et al for their comments regarding our work on statin prescription decision support embedded within the electronic health record.1 We appreciate their interest and the perspective they have added, particularly regarding the important topic of statin intolerance and resistance.

We agree that the evidence base for the prescription of statin therapy for primary and secondary prevention of cardiovascular disease is robust, as is the one illustrating gaps and inequities in guideline-directed statin prescription.2 These gaps can also be exacerbated by the cognitive constraints, biases, and motivation of health care professionals and patients, even throughout the same clinic day, as exemplified by a decrease in new statin prescriptions as a clinic day progresses.3 This calls for the creation, testing, and implementation of multifaceted clinician-focused, patient-focused, and system-focused behavioral strategies aimed at overcoming inertia to initiating and maintaining statin therapy in appropriate patients.

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