“Some women may be less accepting of the fact that they have cardiovascular disease, that they think it’s a man’s disease,” said Dr. Alexander Turchin, lead author of study and director of quality at Brigham and Women’s Hospital. Division of Endocrinology, Diabetes and Hypertension.
Heart disease is often underestimated in women, experts say, due to the misperception that women are protected against heart problems. But the risk of cardiovascular problems in women increases dramatically after menopause.
The study searched the medical records of more than 24,000 patients within the Mass General Brigham Health System from 2000 to 2018. The study, however, did not explore what prompted patients to refuse statins .
The researchers focused on high-risk patients, with an average age of 59, who had coronary or vascular disease, diabetes, very high cholesterol or who had suffered a stroke. All received statins recommended by their doctors to reduce their risk of heart attack and stroke and lower their cholesterol levels.
Dr. Rebekah Gardner, an attending physician at Rhode Island Hospital’s Primary Care Center, said she finds women are more likely to be statin hesitant. She said women may have read or heard of studies involving potential side effects of taking statins, such as muscle pain, and in these studies, women reported problems more frequently.
Gardner said women may also be more likely to share these thoughts and experiences with each other and also more open to trying statin alternatives.
“Women may be more motivated to try lifestyle changes before trying medication, such as changing their diet or exercising more,” Gardner added. “I see that all the time too.”
Who would be the best candidates to try dieting and exercising first?
“For many patients, a trial of diet and exercise would be an entirely reasonable approach and may even be preferred because it would provide benefits beyond cardiovascular risk mitigation,” Gardner said in an e-mail. mail. “Patients in this group may be those with moderately high cholesterol but no heart disease, diabetes, hypertension, smoking, etc.”
But she noted that for patients in the new study, lifestyle changes would be recommended. in addition to statin and not as a substitute.
“Statins would be the strong recommendation here because these patients are a very high-risk group, and, for them, previous research has shown that taking a statin can reduce heart attacks and strokes beyond lifestyle changes alone,” Gardner said.
One finding that surprised Turchin, the study’s lead author, was that the patients most likely to refuse statins were those whose primary language was English. He’s not sure what to make of this, but wonders if these patients are more comfortable searching the internet for statin information and then being swayed by tons of often misleading drug articles.
When Turchin searched sites such as Amazon and Facebook, he said most of the negative information came up.
“The first thing that comes up is ‘life without statins,’ ‘the dark side of statins,’ ‘the truth about statin risks,’ and ‘alternatives to cholesterol-lowering drugs,'” he said.
Turchin, who has received research grants from two companies that make statins, said funds were provided for unrelated studies on obesity and potassium, and pharmaceutical companies had no contribution to the current study on statins.
Other doctors who prescribe statins said the study’s findings of large numbers of patients refusing the drugs ring true in their experiences.
Dr. Russell Phillips, a primary care general internist at Beth Israel Deaconess Medical Center, said often his patients’ decision to start a statin isn’t made in a single office visit, but spans months and several discussions.
And that process, he said, can be difficult for time-pressed primary care physicians who have to explain the need for lifelong treatment with a statin for something that causes the patient no apparent symptoms and which seems like an abstract risk in the future.
“I wish I had resources that I could direct patients to that would outline the risks and benefits for them,” Phillips said.
“There are decision aids created to help patients think about the benefits of mammograms and colonoscopies, but few for that decision,” he said.
The Boston researchers found that the patients most likely to accept statins when recommended were generally those most at risk for heart attacks and strokes: those with diabetes, extremely high levels LDL or “bad” cholesterol, a history of smoking, or had a previous adverse cardiac event.
This matches the experience of Dr. James Udelson.
“Once something bad has happened, it’s easier to get people to (take the drug), to quit smoking after a heart attack or stroke. It’s never easy, but it gets easier,” said Udelson, chief of cardiology at Tufts Medical Center.
The study found that about two-thirds of patients who were recommended statin therapy eventually tried it. And it took three times longer for people in the study who initially refused to take statins to reduce their LDL cholesterol levels to less than 100 milligrams per deciliter (a standard measurement) compared to people who initially said Yes.
Gardner, the Rhode Island hospital physician, said the study provides doctors with valuable information.
“Going into the encounter knowing that people can decline and accept later, that was a discovery that I thought was really encouraging, that they could accept it later and therefore not give up,” she said. .
“Maybe I need to slow down and ask how they see the benefits and the risks, and maybe we can find some common ground.”
Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.