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A fifth of patients in study refused cholesterol-lowering drugs, despite benefits

Tablets of Lipitor, one kind of statin used for lowering blood cholesterol. (Mel Evans/AP)
Tablets of Lipitor, one kind of statin used for lowering blood cholesterol. (Mel Evans/AP)

Cardiovascular disease is the number one killer worldwide. Twenty million U.S. adults have it. Yet, many patients are refusing one of medicine’s best tools for addressing the condition.

A new study in JAMA Network Open, found that roughly 20% of high-risk patients don’t take statins, even when their doctor recommends them. Statins are a group of cholesterol-lowering medications, taken as a daily pill, that have been shown to protect against heart attacks and strokes.

The new study found that one group is particularly resistant to taking this type of medication: women.

WBUR spoke with Alexander Turchin, co-author of the study and the director of quality in the Division of Endocrinology at Brigham and Women's Hospital.

The conversation has been edited for clarity and brevity.

On the results of the study:

"The idea for this research started with my patients. I noticed that some of them did not accept my recommendation of statin therapy, often without ever trying them. And so that made me wonder whether this is part of a broader phenomenon.

"So we conducted a population-based study that involved over 24,000 people. We looked at the data in electronic medical records over nearly 20 years. And we found that, in fact, this is common.

"Even when we focused on individuals at high risk of cardiovascular disease — for example, they already had cardiovascular disease or they had diabetes, which puts people at very high risk for cardiovascular disease, or they had very high cholesterol levels — we found that one in five individuals, when initially recommended statin therapy, do not accept this recommendation from their clinician."

And you also found a gap between men and women, is that right?

"That's exactly right and this wasn't what we expected. We found that women were about 20% more likely than men to not accept a statin therapy recommendation. And as time went on, this gender gap increased. Ultimately, many people change their mind and do accept the statin therapy recommendation. But men are more likely to change their mind than women.

"By the end of the study — we followed people for a little less than eight years — women were 50% more likely, on average, to never accept a statin therapy recommendation compared to men."

Are these differences between women and men a result of them having different medical conditions? Say, one group is more likely to get diabetes or heart disease.

"We looked at that and even when we looked by subgroups — say just patients who have coronary artery disease or just patients who have stroke — we found the same thing. Women are more likely than men to not accept the recommendations of statins."

What are the implications of this in terms of the patient's health?

"The implications can be very significant. Statins decrease their risk of heart attacks. They decrease the risk of ischemic strokes. They decrease the risk of cholesterol building up and blocking blood vessels that supply oxygen and nutrients to the tissues.

"If people aren't taking these medications, they're 20% more likely to have a heart attack or stroke."

"We don't have anything much better than statins and, certainly, we don't have anything that has the combination of low-cost, effective and safe."

Alexander Turchin

What was your reaction when you saw these numbers?

"We really need to work out how best to get the message across to patients. We need to be able to answer the patient's questions, if they have concerns. We need to provide them all the information they need to make their health care decisions and, from what we know, the best health care decision for people at high risk for heart attacks and strokes is to take statins."

Do you have a sense of why patients are refusing statins?

"We didn't specifically address this in the study, so I can only speculate. But there is a lot of misinformation out there that tells people that statins are not a great thing.

"So, for example, if you go to Amazon and you put the word ‘statins’ in the search box, the first things that come back are books with titles like: A Statin-Free Life, The Dark Side of Statins, The Truth About Statins: Risks and Alternatives to Cholesterol Lowering Drugs. I'm not picking these out. These are the top things that come back in my search.

"Then you go to Facebook — and, of course, everyone gets slightly different results — but what I get when I put the word ‘statins’ in the search box is lists of groups with titles like: Stopped Our Statins or No More Statins."

Are there drawbacks, side effects or reasons that patients legitimately wouldn’t want to take statins?

"No medication is without side effects. And there are some side effects that statins have. Some people can get muscle aches, for instance. They may increase your blood sugar slightly. However, the benefits that one can get are very substantial.

"There have been multiple studies, including hundreds of thousands of people, that have shown that statins reduce the risk of heart attacks and reduce the risk of ischemic strokes, particularly in individuals at high risk for these events.

"And, if you try statins and they don’t work, there are alternative medications that you can try. But in our study, very few people tried these alternative medications."

Do we see this type of refusal with other prescription drugs or medical interventions?

"Yes. It's not that uncommon.

"We’ve studied patients with diabetes who had high blood sugars and were offered insulin [by their doctor]. And we found that many of them refused that recommendation.

"Now, to some extent, that might be more understandable than statins because insulin is an injectable medication and some people don't like to give themselves injections. And, since that study came out, there have been alternatives to insulin that have a lot of benefits.

"But we don't have anything much better than statins and, certainly, we don't have anything that has the combination of low-cost, effective and safe."


Gabrielle Emanuel Senior Health and Science Reporter
Gabrielle Emanuel is a senior health and science reporter for WBUR.



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