Many Statin-Eligible Patients Don’t Take Meds, and Say Doctor Is to Blame

Many patients eligible for statin therapy who aren’t currently taking it say they don’t recall ever being offered one of these lipid-lowering agents from their physician, according to a new analysis of the Patient and Provider Assessment of Lipid Management (PALM) registry.

For patients who don’t recall ever being offered treatment, and even those who won’t start given a fear of potential side effects, the findings highlight a need to improve communication between physicians and patients about LDL-lowering therapy, say researchers.  

“This data is patient-reported and certainly that’s a limitation—patients might not have remembered the conversation—but it means the conversations right now aren’t effective enough,” lead investigator Corey Bradley, MD (Duke University Medical Center, Durham, NC), told TCTMD. “We need to improve our communication with people, make sure they understand why we’re bringing this up, and to have this conversation more than once.”

The new study, published March 27, 2019, in the Journal of the American Heart Association, is an attempt to understand why eligible patients, including those at high risk for atherosclerotic cardiovascular disease (ASCVD) and those with prior ASCVD, aren’t taking treatment. “It’s a question that hasn’t really been asked of patients before,” she said. “We wanted to not only understand why patients aren’t taking their statins but also to be able, moving forward, to better incorporate patient preferences and motivations into our discussions about preventive therapy.”

One-Quarter of Eligible Patients Not Taking Statin

The PALM registry was designed to provide a cross-sectional evaluation of lipid management practices and patient and provider beliefs about cholesterol, statin therapy, and heart disease in 140 cardiology, primary care, and endocrinology practices in the United States. Using the 2013 American College of Cardiology/American Heart Association cholesterol guidelines, the researchers identified 5,693 adults eligible for statin therapy.

Overall, 26.5% of eligible patients were not taking a statin. Of the 1,511 patients not taking a statin, 894 reported never being offered the lipid-lowering therapy, 153 declined treatment, and 464 had started but discontinued statin therapy. Black adults, women, and those without health insurance were the least likely to report being offered statin therapy.

Among patients who declined a statin, or who had stopping taking the drug, fear of side effects or perceived side effects was the most commonly cited reason. For those who declined, 25.0% reported wanting to try diet/exercise instead, 19.4% didn’t think they needed one, and 16.0% reported a preference for natural remedies. Among those who stopped a statin, 55% said they had experienced side effects, while 18.2% felt they no longer needed the medication. Cost concerns, a preference for natural remedies, and not noticing an improvement with treatment were some other reasons for stopping.

To TCTMD, Bradley said there is a lot of misinformation in the media about side effects from statin therapy and this could have a serious impact on public health. For that reason, thoughtful conversations about statins with patients are critical, and doctors should encourage patients to bring forward any concerns they have about treatment. In bright news, 60% of patients who had stopped statin therapy were willing to start again. For that reason, instead of viewing patients who declined statins as a “closed door,” it’s an invitation to have the conversation again in the future, said Bradley.