Non-adherence to medication is a global health problem with far-reaching individual-level and population-level consequences but remains unappreciated and under-addressed in the clinical setting. With increasing comorbidity and polypharmacy as well as an ageing population, cardiovascular disease and medication non-adherence are likely to become increasingly prevalent. Multiple methods for detecting non-adherence exist but are imperfect, and, despite emerging technology, a gold standard remains elusive. Non-adherence to medication is dynamic and often has multiple causes, particularly in the context of cardiovascular disease, which tends to require lifelong medication to control symptoms and risk factors in order to prevent disease progression. In this Review, we identify the causes of medication non-adherence and summarize interventions that have been proven in randomized clinical trials to be effective in improving adherence. Practical solutions and areas for future research are also proposed.

不坚持用药是一个全球性健康问题，对个人和人群产生深远的影响，但在临床环境中仍未得到重视和解决。随着合并症和多药治疗以及人口老龄化的增加，心血管疾病和药物不依从性可能会变得越来越普遍。存在多种检测不遵守情况的方法，但并不完善，尽管技术不断涌现，但黄金标准仍然难以实现。不坚持服药是动态的，通常有多种原因，特别是在心血管疾病的情况下，往往需要终生服药来控制症状和危险因素，以防止疾病进展。在这篇综述中，我们确定了药物不依从性的原因，并总结了经随机临床试验证明可有效提高依从性的干预措施。还提出了实际的解决方案和未来研究的领域。