Why many eligible adults aren’t taking these drugs

Date:

  • Researchers report that only 35% of adults who are eligible to take statins for prevention of cardiovascular disease are actually using them.
  • They said that misinformation about statins’ side effects could be a factor.
  • They add that doctors also need more assistance in identifying people who could benefit from statin therapy.

Statin drugs are a front-line preventive therapy for adults with cardiovascular diseases, but many people who could benefit aren’t using them, a new study suggests.

Statin use has increased over time among adults ages 20 and older, according to the research report published in the Annals of Internal Medicine that looked at trends in statin use between 1999 and 2018.

However, researchers reported that general trend largely plateaued in the past five years of the study period (between 2013 and 2018), with only a little more than one in three eligible adults receiving the drugs.

As a class of drugs, statins help lower blood cholesterol, lessening the risk of heart attack and stroke. It’s recommended for people with levels of 190 milligrams per deciliter (mg/dl) or higher of LDL cholesterol, also known as “bad” cholesterol. It’s also recommended for adults ages 40 to 75 with LDL of 70 mg/dl or higher but who also have diabetes or are at high risk of heart attack or stroke.

It’s also recommended to prescribe statins to people following a heart attack or stroke or if they have peripheral arterial disease.

“Statins are medications that reduce the amount of cholesterol your body makes in the liver. In doing so, our liver responds by taking up cholesterol particles in the blood more readily, resulting in less cholesterol in the blood available to damage arteries and cause a heart attack or stroke,” said Dr. Yu-Ming Ni, a cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California who was not involved in the study.

“There is also some data that statins reduce inflammation and stabilize cholesterol plaques in the blood vessels, and this is another way in which statins reduce your risk for heart attacks or strokes,” Ni told Medical News Today.

So why aren’t more people taking statins?

Experts say one reason is a fear of side effects as well as a general perception about statins that doctors say outstrips the actual risks.

“There is a negative stigma associated with statins and a lot of misinformation online that limits statin uptake by the general population,” Dr. Michael Broukhim, an interventional cardiologist at Providence Saint John’s Health Center California who was not involved in the study, told Medical News Today.

Statins have been linked to muscle pain and weakness as well as joint pain, but these cases are relatively rare and can often be corrected by switching a particular statin to another drug in its class.

“I have heard patients complain that cholesterol is not important for reducing heart disease, that statins damage the liver and cause dementia, and even that doctors are in cahoots with pharmaceutical companies to make money off statins,” Ni said.

“Statins may cause muscle aches due to overlapping effects of the medication on muscle cells, but for most patients, this is temporary and resolves after two weeks,” he added. “Statins do not increase the risk of dementia. Statins are inexpensive and available in generic form and are one of the most cost-effective treatments we have for fighting the number one killer in America: heart disease.”

However, it’s not just misinformation that’s getting in the way of statin uptake among people who should be taking the drugs.

“Unfortunately, this study’s findings are not new,” Ni said. “The medical community has been working on improving access to statin treatment for many years. There are many factors that make it challenging to increase statin use in the community.”

One of those factors is doctors themselves.

The American College of Cardiology and the American Heart Association Task Force issued guidelines in 2013 that significantly expanded which patients should be prescribed statins for primary prevention of heart attack and stroke.

These guidelines, while potentially life-saving for millions of Americans, “also increased decision-making complexity, requiring new multistep risk calculation,” according to the new study.

“Our findings showed a lower rate of statin use among patients meeting criteria based on ASCVD risk than among those with easily identifiable indications, such as diabetes or a low-density lipoprotein cholesterol level above 190 mg/dL,” the authors wrote. “Many clinicians do not routinely use cardiovascular risk calculators because of lack of time, input availability, or buy-in.”

“Electronic health record tools that calculate ASCVD risk show promise, but they are not routinely implemented and do not address other barriers, such as competing patient priorities and limited time for shared decision making,” they added.

Read the full article here

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