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Therapeutic Inertia in Lipid-Lowering Treatment: A Narrative Review
Marco Vatri1, Andrea Faggiano2, Elisabetta Angelino3
1Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, 50121 Firenze, Italy.
Journal of Clinical Medicine
|February 13, 2026
Summary
Therapeutic inertia, where patients with high cardiovascular risk do not receive timely lipid-lowering treatment intensification, leads to an avoidable atherosclerotic burden. Addressing this gap is crucial for preventing cardiovascular events and reducing healthcare costs.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Services Research
Background:
- Therapeutic inertia in lipid-lowering treatment is a paradox in cardiovascular medicine.
- Most high-risk patients do not achieve guideline-recommended LDL-cholesterol targets.
- This gap between evidence and practice leads to avoidable atherosclerotic burden.
Purpose of the Study:
- To examine therapeutic inertia in lipid-lowering treatment for secondary cardiovascular prevention.
- To describe its epidemiology, mechanisms, and clinical consequences.
- To propose clinician phenotypes and the concept of avoidable atherosclerotic burden.
Main Methods:
- Narrative review of contemporary European and international data.
- Analysis of physician-, patient-, and system-level determinants of inertia.
- Characterization of clinician phenotypes and the concept of avoidable atherosclerotic burden.
Main Results:
- Fewer than one-third of secondary prevention patients achieve LDL-C targets.
- Therapeutic inertia contributes to cumulative vascular injury and increased cardiovascular events.
- Clinician phenotypes and system-level factors perpetuate inertia.
Conclusions:
- Overcoming therapeutic inertia is a clinical and ethical imperative.
- Strategies like upfront combination therapy and AI can shift lipid management to proactive care.
- Transforming optimal lipid management into a system-level default is essential.
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