Therapeutic Inertia in Lipid Management: Overcoming Barriers in Primary Care

A recent narrative review shows that many at-risk patients remain above LDL‑C targets despite clear evidence that cumulative LDL‑C exposure increases cardiovascular event risk. Therapeutic inertia—delays in intensifying lipid-lowering therapy—prolongs this exposure and demands practical primary-care solutions.

Clinician- and system-level drivers include competing visit priorities, gaps in risk assessment, delayed intensification, and fragmented care pathways. These factors create missed opportunities to intensify therapy, raise patient risk, and widen disparities when follow-up or access is inconsistent.

Primary care workflows that reduce delays include point-of-care risk calculators, predefined lipid follow-up (eg, LDL‑C recheck 4–8 weeks after initiation or dose change), standing orders for refills and uptitration, and structured specialty handoffs.

Upfront combination therapy is reasonable for patients with very high baseline LDL‑C, established ASCVD with high absolute risk, or when high‑intensity statin monotherapy fails to achieve an adequate response by 6–8 weeks. It's important to begin a high‑intensity statin promptly, schedule an early reassessment, and add nonstatin agents sooner when the likelihood of reaching target with statin alone is low—reducing dependence on delayed titration.

Key Takeaways:

• Therapeutic inertia is a leading cause of prolonged LDL‑C exposure and requires clinician- and system-level solutions.
• Operational steps (EHR alerts, scheduled LDL checks, standing orders, clear handoffs) shorten time above target.
• Consider early combination therapy for very high LDL‑C, established ASCVD with high risk, or inadequate response at 6–8 weeks.