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Patients say lack of physician guidance and fear of side effects are why they don't take statins as prescribed

March 27, 2019

DALLAS, March 27, 2019 -- Despite national guidelines indicating that statins can lower risk of heart attack and stroke, many patients who could benefit do not take them. More than half of eligible patients say they were never offered the cholesterol-lowering drugs; the experience of side effects or fear of side effects were reasons for stopping or refusing statins, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

Statins lower the amount of low-density lipoprotein (LDL, or "bad" cholesterol) and have been shown to lower the risk of heart attack and strokes. Because statins are proven effective and have a low risk of side effects, guidelines from the American Heart Association/American College of Cardiology recommend doctors use an atherosclerotic and cardiovascular disease risk calculator to give a detailed assessment of a person's 10-year risk for heart disease and to help create a personalized plan.

"We need to focus our efforts on improving how doctors identify patients who need to be on a statin, and how they present information to patients to ensure that no one is missing the opportunity to improve their heart health," said Corey Bradley, M.D., lead author of the study and a researcher at the Duke Clinical Research Institute in Durham, North Carolina.

To find out whether eligible patients use statins, and why they sometimes decline or discontinue the drugs, researchers surveyed 5,693 adults (average age 68) who participated in a registry for those receiving medical care at a cardiology, primary care, or endocrinology practice.

Researchers found:
  • Of the 1,511 (26.5 percent) who were not currently taking statins, 59.2 percent reported that they had never been offered them.
  • Patients were more likely to report never being offered a statin if they were female (22 percent higher than others), black (48 percent higher than others), or without insurance (38 percent higher than others).
  • Patients seen in cardiology practices were more likely to be offered a statin than those in primary care.
"It is possible that some people did not remember being offered a statin, so we may have over-estimated the percent who were never offered one. However, we believe that if the patient did not remember the conversation, the discussion likely was not an effective one," Bradley said.

Of the patients who declined (10.1 percent) or discontinued (30.7 percent) statins, the most common reasons given were a fear of side effects and perceived side effects. Compared with statin users, non-users were less likely to believe statins are safe.

"Although there are risks associated with statins, the public fear of side effects is out of proportion to the actual risks," said Ann Marie Navar, M.D., Ph.D., senior author of the study and assistant professor of Medicine at the Duke Clinical Research Institute. "Misconceptions about statins are everywhere and are fueled by false information on the internet. We need better tools to help combat this type of misinformation."

Despite their concerns, in the survey 59.7 percent of patients who discontinued a statin would consider retrying it.

"Physicians should not hesitate to re-approach the conversation about starting or re-trying statin therapy in patients who could benefit but are currently not on the therapy," Bradley said.
-end-
Co-authors are Tracy Y. Wang, M.D., M.H.S., M.Sc.; Shuang Li, M.S.; Jennifer G. Robinson, M.D., M.P.H.; Veronique L. Roger, M.D.; Anne C. Goldberg, M.D.; Salim S. Virani, M.D.; Michael J. Louis, M.D., M.P.H., M.Sc.; L. Veronica Lee, M.D.; Eric D. Peterson, M.D., M.P.H.; and Ann Marie Navar, M.D., Ph.D. Author disclosures are on the manuscript.

Sanofi, Regeneron, and the National Heart, Lung, and Blood Institute funded the study.

Additional Resources: Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

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