Why aren't cholesterol patients taking their drugs?
Half of the people who could benefit from cholesterol-lowering drugs aren't taking them, a large new study shows.
More than a third of American adults fall under criteria that make them eligible to take medications that will lower their LDL or "bad" cholesterol levels, but a report by CDC researchers shows nearly half aren't popping the pills. The study found African-Americans and Mexican-Americans are less likely than whites to use medication.
The report also showed that less than half of people with high cholesterol were making lifestyle changes that could help them sidestep heart disease, such as regular exercise, a heart-healthy diet, and shedding pounds.
"This study reveals opportunities to reduce existing disparities through targeted patient education and cholesterol management programs," Dr. Carla Mercado, a scientist in the Division for Heart Disease and Stroke Prevention at the CDC, said in a statement.
She said close to 800,000 people die in the U.S. each year from cardiovascular diseases. "That's one in every three deaths - and high cholesterol continues to be a major risk factor," Mercado said.
While medication rates and lifestyle changes lag, the authors also offered one positive note: the number of Americans with high cholesterol levels dropped between 2007 and 2014.
Dr. Chip Lavie, medical director of Cardiac Rehabilitation and Prevention at John Ochsner Heart and Vascular Institute, in New Orleans, told CBS News there are layers of reasons why patients don't take cholesterol-lowering medications even when doctors say they should.
"Bad lipids do not make one feel badly until the heart attack, heart failure, or stroke occurs," he said. People who feel fine may think the drugs aren't really needed, or may not be willing to put up with side effects.
The cost of medications, concern about adverse effects - real and perceived - and a lack of communication between health care providers and their patients are among the other issues that get in the way, Lavie added.
Dr. Ileana Piña, chair of the council on clinical cardiology for the American Heart Association, said, "I work in the Bronx, not a very rich borough. I hear patients say they don't have money for the co-pay."
Piña, also a professor of medicine and epidemiology and population health at Albert Einstein College of Medicine, said older patients sometimes run out of medication before they receive their Social Security checks, or can't get transportation to their pharmacy to pick up their prescription.
Fear of possible side effects also stops many patients from taking the drugs - or even trying them in the first place.
Some statin users have reported cognitive impairment, such as memory loss, forgetfulness and confusion. A study published in June in JAMA Internal Medicine showed that more patients taking statins reported short-term memory loss in the 30-day period after first taking the drug when compared to people not taking any cholesterol-lowering drugs. However, the same was true for patients taking non-statin cholesterol-lowering drugs.
Other side effects may include increased risk of raised blood sugar levels and developing type 2 diabetes, according to the FDA, or complaints of muscle pain and damage.
Piña said reports of these types of problems spread widely.
"A lot of it is cultural. If you chit chat with your neighbor and they're taking the medication and having a lot of aches and pains from their statin, you may be less likely to want to take yours, too," she said.
But the side effect risks shouldn't scare people off from considering statins, Dr. Amy Egan, deputy director for safety in the FDA's division of Metabolism and Endocrinology Products said in a statement posted on the FDA's website prior to this new research.
"The value of statins in preventing heart disease has been clearly established," Egan said. "Their benefit is indisputable, but they need to be taken with care and knowledge of their side effects."
And then there are patients who don't believe medications are doing anything for them, Piña added.
But, as Egan indicated, she said patients need to know that taking lipid medications as prescribed can substantially reduce cardiovascular events, including heart attacks and stroke, and reduce a person's risk for death.
Getting people to take their medicines - for cholesterol and other medical issues - requires a lot of patient communication and education, Piña said.
"Sometimes education is better done not by physicians but by pharmacists, nurse practitioners, even coaches. We can all do a much better job of sitting down with patients and finding out why this person isn't taking the drugs," she said.
Teaching patients that they don't have to get dressed in expensive gear and sneakers in order to exercise is another important message health care providers need to get across, she said. Just moving, whether it's walking, gardening, or anything a patient enjoys, can improve health.
"It takes a village to get patients to be adherent," she said.
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