A recent study from the University of Nottingham found that more than half of the patients taking statins did not optimally lower their cholesterol, placing those patients at an increased risk of a heart attack or stroke.
For the 56 million U.S. adults, 40 or older, who have high cholesterol, statins can be a lifesaver. The American Heart Association has long recommended statin therapy as a way to lower LDL cholesterol and reduce the risk of a heart attack or stroke in patients who already have heart disease or who exhibit risk factors, such has being obese or smoking, having high cholesterol, diabetes, or high blood pressure.
“Several dozen trials in the past 30 years have demonstrated efficacy and safety of these medications in cardiovascular risk reduction,” says Dr. Rhanderson Cardoso, a cardiology fellow at Johns Hopkins Medicine, Division of Cardiology.
While the study did not detail the reasons for patients having a suboptimal response, one reason may be that the patients were not taking the right statin. According to Cardoso, those study participants with a less than optimal response were prescribed lower-intensity statin therapy and the study used the standard of a 40% reduction in LDL-C that only applies to patients started on high-intensity statin therapy. When it comes to primary prevention, most patients are started on a moderate-intensity statin, which only decreases LDL-C by 30-50% on average.
“Therefore, over a 40% reduction in LDL-C is not anticipated across the board in primary prevention patients,” says Cardoso.
The study mentioned, but did not detail, the incidence of noncompliance. While some patients’ statin regimen may need adjusting to work more efficiently, the most common reason that regimens don’t work is that patients don’t take the statin.
“It is nearly impossible for patients not to reduce cholesterol if they take a statin as prescribed,” says Joseph Saseen, PharmD, professor and vice chair, department of clinical pharmacy, University of Colorado Anschutz Medical Campus. “Some may not see optimal reduction, but if cholesterol is not lowered, it is 99.99% because of nonadherence.”
In some cases, patients don’t take statins as prescribed because they don’t fully understand the purpose of their medication or have misconceptions that lead them to be skeptical of the benefits versus risks.
“Pharmacists are in an excellent position to help out with this, as we are the last step between picking up the prescription and taking the medication regularly to decrease the risk of medical harm (heart attacks, strokes, etc.),” says Saseen.
There are several reasons patients may not fill or refill a statin prescription. One is the lack of obvious symptoms associated with elevated cholesterol. Patients may have a prescription, but they don’t feel sick.
“It’s not like having a cold, where you feel symptoms and take something to feel better,” says Stefanie Ferreri, PharmD and APhA spokesperson. “You take a statin because a physician tells you to, but you don’t feel sick. That’s why patient education—every time a patient fills a prescription—is an important part of ensuring that patients will continue to take their prescriptions. The study did not touch on patient education.”
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