According to a new Harvard study published on February 28 in Open JAMA Network.
The findings highlight the disturbing number of people who refuse statins and suggest doctors need to have more conversations with patients about why, says study co-author Alex Turchin, MD, associate professor at the Harvard Medical School in Boston and the Director of Quality in Brigham’s Division of Endocrinology, Diabetes and Hypertension.
“Given that cardiovascular disease, heart disease, and stroke together are the number one killer in the United States and globally, this is something that could have major implications,” he says. Nearly 700,000 Americans died of heart disease in 2020, or 1 in 5 deaths, according to the Centers for Disease Control and Prevention (CDC).
Women were more likely to refuse statin treatment
After noticing that many of his patients with one or more risk factors for cardiovascular disease were not following his recommendation to take a statin, Dr. Turchin decided to design a study to see if this was a trend. in the whole population.
The retrospective study included 24,212 adults who were seen at the Mass General Brigham Healthcare Delivery Network between January 1, 2000 and December 31, 2018. The study focused on high-risk patients who had coronary or vascular disease, diabetes, cholesterol (an LDL of 190 milligrams per deciliter (mg/dL) or higher), or had suffered a stroke. Participants were 51% female, 73% white, 8.5% black, 6% Hispanic, 4.3% Asian, and 8.2% other races.
All of the subjects had statins recommended by their doctors to reduce their risk of heart attack or stroke, according to vendor notes. All participants were then followed via their electronic health record for an average of eight years.
After analyzing the records, investigators found the following trends:
- More than 20% refused to take statins when they were first offered the drug, even though they were all considered high risk.
- Women were 20% more likely than men to refuse initially: 24.1% versus 19.7%.
- Over the eight years of follow-up, almost 2 in 3 people who initially refused statins eventually tried them, but women were 50% more likely to never accept the recommendation: 7.2% of women versus 4.8 % men.
The study also showed that people who initially refused statin treatment developed higher LDL (“bad”) cholesterol levels. It also took them three times longer to reduce their LDL cholesterol to less than 100 than people who initially said yes.
It was an intriguing study, says Wesley Milks, MD, cardiologist and clinical assistant professor of internal medicine at Ohio State Wexner Medical Center in Columbus, Ohio, who was not part of the research.
“It is important to note that the researchers excluded people who had previously documented an adverse reaction to statin therapy, which I believe is important so that the results can be extrapolated to new statin recommendations,” explains Dr. Milks.
What’s to blame for people’s reluctance to take statins?
For people who receive a doctor’s recommendation to take statins, “the benefits far outweigh the risks,” according to the American Heart Association. In an analysis of the risks and benefits of statins, the organization concluded that “more than 30 years of clinical investigations have shown that statins have few serious adverse effects”.
Milks agrees, saying, “Statin therapy is highly effective, inexpensive, and generally well tolerated in people with high cholesterol and/or high risk of atherosclerotic cardiovascular disease.”
But simple internet research can help explain why some people are hesitant to take statins, Turchin says. “For example, if I go to Amazon to search for a book on statins and just type ‘statins’ in the search box, at the very top are all the books about why statins are bad for you. They have titles about “the dark side” of statins, or how to live life “without statins,” he says.
On Facebook, a search for statins also leads to groups such as “No More Statins” or “Stopped Our Statins,” he says. “If that’s the kind of information people are exposed to, in some ways, it’s no wonder some of them get that message and say no when recommended,” Turchin says.
Why do so many women refuse statins?
“We were surprised that so many women refuse statins compared to men; we didn’t expect to see such a big difference,” says Turchin.
Milks agrees that the results on men and women are interesting, but they match his clinical experience as a preventive cardiologist and lipid specialist. “I find that women may be slightly more likely than men to refuse statin treatment, although my practice is largely focused on patients who have had at least one and usually several previous exposures to statins,” he says. . In this study, people were offered statins for the first time.
This study does not examine the “why” behind the results, but Milks offered a few theories. “One possible explanation is that women are more likely than men to believe that drugs to lower cholesterol and/or risk of atherosclerotic cardiovascular disease are unnecessary,” he says.
While it’s true that, on average, women are at less risk of heart attack or stroke than men, cardiovascular disease remains the leading cause of death for both sexes, says Milks.
Research indicates that many women are unaware of this. When asked, only 56% of women agree that heart disease is the number one killer, according to the CDC.
The perception that heart disease should be less of a concern for women than for men has contributed to disparities in diagnosis, treatment and advocacy at the expense of women in previous decades, Milks says. “I support the American Heart Association’s Go Red for Women campaign to raise awareness of this issue and support the growth of programs that focus on correcting these disparities,” he says.
Women may have a higher rate of statin intolerance
One potential reason why so many women refuse statins is that they are more likely than men to have concerns about adverse drug effects — in this study, women had more documented drug allergies ( 2.8% versus 1.3%) than men, says Milks.
“Additionally, several previous studies have suggested a higher rate of statin intolerance in women compared to men, which may be related at least in part to differences in body size,” he says.
Statin therapy can cost less than $5 a month, even without insurance
Patients who refuse to take statins may be concerned about the cost. They may not know that the most potent statins, rosuvastatin and atorvastatin, along with many others, are generic drugs that cost as little as $4 to $10 a month, even without prescription insurance, said Milks.
More research is needed to find out why people refuse statin treatment
The study results show that patients “are active agents in their care, and their preferences and priorities should be carefully considered when making treatment recommendations,” the authors wrote. Further research is needed to identify why some patients refuse statin treatment, the authors noted.
Turchin is currently studying the impact of non-acceptance of statin therapy on heart attacks, strokes and death. “I think people underestimate how much of a difference modern medicine has made in extending people’s lives and (improving) their quality of life, and drugs can play a big part in that. “, he says.