With serious health problems like obesity and type 2 diabetes on the rise in the U.S., the number one cause of death in our nation remains cardiovascular disease from heart attack and stroke. This is typically a result of atherosclerosis, which is a condition in which the walls of the artery become diseased and block blood flow to the heart.
According to recent calculations, half of all adult Americans have abnormal lipids, or cholesterol levels. As for what the best solution is, Dr. Eliot Brinton – director of the National Lipid Association – suggests that while cholesterol medications, or statins, are the most common answer, many patients are hesitant to comply.
In fact, recent studies indicate that nearly 75 percent of new statin users stop therapy by the end of the first year. This is especially concerning considering statin adherence often leads to an increased risk of adverse cardiovascular outcomes that contribute to the rising costs of heart disease, which is expected to reach $818 billion by 2030.
According to Brinton, statins are the number one class of drugs in the U.S. in terms of cost and sales. “We use statins because they are very affective at lowering levels of the bad cholesterol and reduce cardiovascular events by one-third.”
However, according to objective surveys, statin adherence or compliance remains a huge problem for patients with high cholesterol. This information comes according to a new USAGE study (Understanding Statin Use in America and Gaps in Education), which was the largest ever patient survey on this subject.
Results showed that of the more than 10,000 participants involved in the survey who had been prescribed a statin and were willing to respond, 88 percent were still on a statin, roughly 50 percent had switched their statin at one point in time, and 12 percent were no longer using statins.
Brinton reported that of those who switched statins, cost was the primary reason given. And among those who’d gone off statins altogether, usually without doctor recommendation, adverse side effects were by far the primary reason.
Dr. Brinton explained that while some people on statins experience muscle symptoms as the primary adverse side effect, there are often other factors at play. And while there are other drugs that help control cholesterol, statins are the class of drugs that medical experts have the most evidence on – even to the point of proof, Dr. Brinton suggests – for preventing heart attack and stroke.
Though medications seem like the easy solution for controlling cholesterol levels, we asked Dr. Brinton how often lifestyle changes are recommended to patients with high cholesterol. “Our guidelines always strongly encourage us to make the diet and lifestyle the first step,” he said. “We can give medications on that first visit, but those recommendations should come first.”
However, realistically that can be a difficult thing according to Dr. Brinton who says he often deals with patients who are not willing to change their diet. “A lot of patients view it as a downer to be told they can’t have the Big Mac and the giant steak. There is a little bit of a tug of war going on.”
In addition to patient resistance, Dr. Brinton points out the issue that diet and lifestyle are limited in what they can do for cholesterol management. “If someone changes their diet and lifestyle to a more healthy approach – such as adding physical activity, cutting back saturated fat intake, or losing weight – virtually 100 percent of those patients will see some improvement,” he said. However, only a small percentage of the patients can do that successfully while the majority will still need medication on top of diet and lifestyle changes.
So, if doctors aren’t necessarily to blame, patients are inevitably going to make the choices they want regardless of doctor recommendations, and the prescribed medications often have side effects, what is the ultimate solution?
“The best approach is in the middle,” said Dr. Brinton, explaining that it’s ideal to have a good patient-doctor relationship so that the two can work together to find the best solution.
Brinton also points out that extreme dieting isn’t the best approach either. “We know for a fact that certain diets can regress atherosclerosis. The problem is, not everyone responds to those diets and not everyone can do those longterm,” he said, citing Bill Clinton as a rare example of someone who relied on a vegan diet to manage their condition.
“For weight loss, only 5 percent of patients at best manage to maintain weight loss over a five year period.” For this reason, Brinton would argue that each person should find the right diet for them that’s sustainable over a lifetime. Otherwise, it likely won’t stick and will only cause more problems in the long run.
In short, Dr. Brinton stresses the importance of patients forming a healthy, trusting relationship with their doctor in which there is room for trial and error when it comes to medication and lifestyle changes. In addition, the patient should expect plenty of follow up appointments to continue finding the best solution over time.
Of course, the ideal solution is for people to tend to their health at a young age so they avoid problems like high cholesterol later in life. Dr. Brinton agrees, saying we should be taking this message to high school and middle school kids, teaching them about the importance of good health early in life to prevent diseases down the road.
“We cannot have blinders on and neglect key issues – and certainly primordial prevention in kids is an extremely important piece that sometimes is not even mentioned,” he said.
For those who are on statins or are considering using them for cholesterol management, Dr. Brinton recommends visiting statinusage.com for a great resource and guide on how to optimize medication effectiveness.
September 19th, 2012