More than 20% of patients at high risk of developing cardiovascular disease refuse to take recommended statin medications, and women are 50% more likely than men to opt out, finds a study involving 24,000 participants.
The number of refusals is alarming, and reveals a need for clinician-patient discussions about the importance of statin therapy, according to Alex Turchin, MD, of Harvard Medical School and a director of quality at Brigham and Women’s Hospital in Boston. “We need to better understand what our patients’ preferences are and to be able to provide more patient-centered care,” he said in a statement.
Refusals impact health goals
Study participants had coronary artery or vascular disease, diabetes, very high cholesterol or a history of stroke. In all cases, the patients’ physician recommended statin medications to cut heart attack and stroke risk and to reduce cholesterol levels.
About two-thirds of the patients eventually tried taking statins, and about one-third never did. Refusal appeared to have a big effect on efforts to reach health goals. It took three times as long for people who initially rejected statins to reduce their LDL cholesterol levels to less than 100, when compared to people who initially opted to take the drugs. Reducing LDL cholesterol is a key goal of statin therapy, meant to curtail the risk of adverse health outcomes.
Disparities in women?
The researchers found the higher rate of refusal by women surprising. They theorized that this finding may be due in part to a misconception that heart disease affects men more than women. Fewer women taking statins as recommended could contribute to the known sex disparities in treatment of high cholesterol, they added.
“Ultimately, we need to talk to our patients and find out in more detail why they would prefer not to take statins,” Turchin said. “I think people underestimate how much of a difference modern medicine has made in extending people’s lives and their quality of life.”
The debate about statins for seniors, LTC
Despite evidence for the benefits of statins, there has been considerable debate about the appropriate use of these drugs to treat elderly adults, and their role in polypharmacy. The authors of guidance released in August 2022 have questioned whether there is sufficient data to assess benefits and harms of statins for primary prevention of cardiovascular events and death in adults aged 76 years or older. And a national study in long-term care facilities published in 2020 found that one third of residents aged 65 and older remain on statins – with some on high-intensity doses — despite having life-limiting illnesses.
But statins can help to lower mortality risk in adults aged 75 and older, other studies have found. One study from France found that healthy 75-year-olds who stop taking statins have a 33% increased risk of being sent to the hospital with heart and blood vessel problems.
Heart disease is a leading cause of death in the United States, according to the Centers for Disease Control and Prevention.
Full findings were published in JAMA Network Open.
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