Most statin-eligible patients not on the drug say it was never offered

Nearly 60 percent of patients who met guideline-based criteria for statin therapy but weren’t taking the cholesterol-lowering drugs said they were never offered one, according to a study published March 27 in the Journal of the American Heart Association.

“It is possible that some people did not remember being offered a statin, so we may have overestimated the percent who were never offered one,” lead author Corey Bradley, MD, with Duke Clinical Research Institute in Durham, North Carolina, said in a press release. “However, we believe that if the patient did not remember the conversation, the discussion likely was not an effective one.”

Statins are recommended as a first-line therapy to lower LDL cholesterol given their proven effectiveness, low cost and relatively low risk of side effects. But previous research has highlighted that many patients who could benefit from these medications either stop taking them or were never prescribed them in the first place.

Bradley et al. studied 5,693 adults from 140 U.S. practices who fulfilled the criteria for a statin recommendation based on the 2013 American guidelines. Overall, 26.5 percent of those patients said in an iPad-administered survey they weren’t taking statins.

Of that group, 59.2 percent reported never being offered a statin, 10.1 percent declined a statin and 30.7 percent had discontinued therapy.

Notably, black adults were 48 percent more likely to say they’d never been offered a statin. Women and people without insurance were 22 percent and 38 percent more likely, respectively, to report never being offered the treatment.

But a large opportunity exists to increase statin uptake, the authors found. More than two-thirds (67.7 percent) of those who were never offered a statin said they would consider taking one, and 59.7 percent of people who had stopped taking a statin said they would consider retrying a statin.

“We need to focus our efforts on improving how doctors identify patients who need to be on a statin, and how they present information to patients to ensure that no one is missing the opportunity to improve their heart health,” Bradley said.

In a related editorial, Lynne T. Braun, PhD, CNP, said clinicians must initiate a thorough discussion with patients to discuss the risks and benefits of the drugs before prescribing a statin. Even though the risk of serious adverse effects was below 1 percent in clinical trials, she explained, patients often have overblown fears about statin-related muscle pain and weakness, liver damage and memory problems based on Internet research or conversations with nonclinicians.  

Indeed, in Bradley et al.’s study, fear of side effects or perceived side effects were the most common reasons for declining or discontinuing therapy.

“A discussion about potential adverse effects of statins may help the clinician learn what the patient knows about risks or side effects and can correct any misinformation,” Braun wrote. “It is often helpful at the initial conversation to inform patients that 7 statins are available and they have different pharmacological properties; if a patient has a side effect to 1 statin, often a different statin will be well tolerated.”

Braun said it’s also important to let patients share their preferences when it comes to initiating statin therapy, and to let them know that clinical staff are available via phone to discuss any concerns. These approaches could build trust in the patient-clinician relationship, she wrote.