If you knew a medicine could save your life, what would stop you from taking it?
This was the unsolved question Kowa Pharmaceuticals America (Kowa) and Eli Lilly and Company (Lilly) set out to answer with USAGE—Understanding Statin use in America and Gaps in Education, the largest cholesterol survey of more than 10,100 patients.

Statins are the standard-of-care medicines physicians prescribe to patients with high cholesterol, a major risk factor for heart attack and stroke. Yet while heart disease remains the #1 killer of men and women, 75% of patients stop taking their statins within one year.


So why do patients stop taking statins?
The answers surprised even physician experts. USAGE survey data showed the most common reason for stopping or switching statin treatment was side effects – a finding tied directly to patient-physician dialogue.

Kowa and Lilly collaborated with the National Lipid Association (NLA) and patient spokesperson John O’Hurley (Seinfeld) to launch the USAGE education campaign. Informed by USAGE survey data, the campaign delivered – through integrated communications – actionable steps bridging knowledge gaps between doctors and patients to improve conversations about cholesterol and sticking with treatment.

Campaign results include nearly 1 billion media impressions from news media coverage of the USAGE survey, 97% key message penetration, and demonstrable changes in behavior among physicians who state in follow-on surveys their intention to use the new information from USAGE to inform their clinical practice and interactions with patients in order to improve statin adherence.

Recognized by the American Heart Association (AHA) as peer-reviewed data, NLA leaders presented USAGE findings during the AHA annual meeting of 16,000 cardiologists and physicians in November 2012 to a standing-room only audience.

Program Objectives

  1. Educate patients and physicians on USAGE results, as measured specifically by:
    1. Enlist 35% of cholesterol management specialists to incorporate guidance from USAGE survey findings into clinical practice.
    2. Achieve 1,000 downloads of the USAGE Patient Discussion Guide from the campaign website
  2. Generate 500 million media impressions in national news coverage. Specifically, secure inclusion of statin side effects as central reason why patients stop taking their statins in 80% of USAGE news media coverage.
  3. Increase awareness of Kowa within the medical community, as measured specifically by:
    1. Create 500 new relationships with physicians (20% of U.S. cholesterol management specialists).

Target Audiences

  • Patients with high cholesterol—adults age 30+
  • Physician experts who specialize in helping patients manage high cholesterol
  • Healthcare providers (e.g., primary care physicians, cardiology nurses) and professional organizations

USAGE results showed the leading reason for non-adherence was medication side effects (62%); more than 3.5 times more than medication cost (17%). This surprising data point became a call-to-action to encourage physician-patient conversation around side effects as an important part of the care dialogue.


Cholesterol Medications Don’t Work If You Don’t Take Them

Kowa and Lilly’s partnership with the NLA, the leading cholesterol research organization in the U.S., created new ties to cardiovascular thought leaders who helped to cascade USAGE learnings reaching the broader health care network. This helped create a new understanding among clinicians of the link between prescribing a medication and importance of ensuring patients follow-through in taking it every day.

For the patient audience, the team enlisted a well-recognized spokesperson to put a face to high cholesterol. The celebrity humanized the consumer’s struggle and inspired new understanding of the need to stay on statin treatment despite obstacles such as side effects and cost. Targeting was determined using Centers for Disease Control and Prevention (CDC) research, focusing on cities with the highest incidence of high cholesterol.


      • Invited Independent Panel of Experts: Identified and assembled cholesterol opinion leaders to oversee survey design and validate clinical significance of improving patient care for high cholesterol.
      • Secured Partnerships: Gained interest and partnership of the NLA and medical survey group capable of conducting comprehensive survey of more than 10,100 patients.
      • Educated Experts on USAGE Findings: Announced survey results at the NLA annual meeting, the largest gathering of cholesterol management specialists, in June 2012, and presented additional data at the AHA annual meeting in November 2012.
      • Published USAGE Data: NLA published USAGE data in the May/June issue of the Journal of Clinical Lipidology. The team developed a resource kit for 12 professional and advocacy organizations to share and syndicate content with constituents.
      • Created USAGE Campaign Website with Shareable Resources: Materials on included discussion guides and a PowerPoint presentation for physicians interested in presenting USAGE data to colleagues.
      • Empowered Patients Nationwide with News Media Blitz: Launched campaign in June featuring celebrity high cholesterol patient John O’Hurley and NLA spokesperson Dr. Eliot Brinton. Activities included deskside briefings, national TV interviews, and an SMT.
      • Expanded Engagement with American Heart Association: Expanded campaign in Los Angeles supporting USAGE data presentation at the AHA annual meeting where on-site coverage reached professionals in attendance. Activities included national and trade media outreach, appearances on national TV, and a RMT reaching national and local markets.


  1. Fifty percent of physicians plan to make changes in their practice based on USAGE information and 83% recommend their patients visit, according to a post-campaign survey of 2,300 NLA members.
    1. More than 5,000 physicians requested USAGE materials from the NLA and other organizations.
    2. AHA offered a presentation dedicated to statin adherence during its national meeting, where 16,000 physicians and cardiologists attend to hear breaking science.
    3. 2,300 consumers accessed downloadable tools to bring the conversation into the doctor’s office.
  2. News media coverage of USAGE reached more than 921 million patients and 4 million healthcare providers (150% above target), including Family Circle, CNN, Fox & Friends, Hallmark Channel, MedPage Today, SCRIP Intelligence, Doctor Radio (Sirius XM), and Lifescript.
    1. Local interviews in more than 141 cities, including coverage in 95% of the states with the highest heart disease rates.
    2. 98% of coverage discussed side effects as the chief motivator behind stopping or switching treatment.
  3. Kowa corporate visibility increased 475% in year-over-year news media coverage.
    1. Established 850 new relationships with customers on-site at scientific presentations at medical meetings, including the AHA annual meeting (70% above target).