Initiating antihypertensives, statins increases likelihood of obesity

People who begin taking antihypertensive drugs or lipid-lowerers like statins are more likely than non-initiators to become obese and physically inactive, a Journal of the American Heart Association study has found—but they’re also more likely to quit smoking and keep their alcohol intake in check.

First author Maarit J. Korhonen, PhD, and co-authors said in JAHA that it’s unknown whether or how initiating preventive medications like statins or BP-lowering drugs affects patients’ lifestyle decisions, but for anyone at an increased risk for CVD, lifestyle modifications are important. On one hand, the team said, patient education and lifestyle counseling should precede any kind of prescription, so users may have a better grasp of their CV risk and adhere to their meds. 

On the other hand, they could view their prescriptions as a proxy.

“The perceived effectiveness of pharmacotherapy may provide an incentive to adhere to a lifestyle that also prevents other diseases,” Korhonen, of the University of Turku in Turku, Finland, and colleagues wrote. “The counterargument is that individuals may substitute medications for a healthy lifestyle and continue an unhealthy lifestyle or even engage in it, which may reduce the effectiveness of pharmacotherapy.”

The authors reviewed the data of 41,225 participants in the FPS (Finnish Public Sector) study, all of whom were 40 years old or up and free of CVD at baseline. All individuals filled out at least two consecutive surveys between 2000 and 2013.

Korhonen et al. obtained medication use data for 8,837 statin or antihypertensive initiators from pharmacy claims, comparing any changes in their BMI, physical activity, alcohol consumption and smoking status to those in a population of 46,021 non-initiators. They found that patients who initiated medication:

  • Saw an increase in body mass index (difference in change: 0.19)
  • Were 8% more likely to be physically inactive
  • Were 82% more likely to become obese
  • Drank less (an average decrease of -1.85 grams of alcohol per week)
  • Were more likely to quit smoking cigarettes 

Korhonen and her team said their findings suggest patients’ awareness of their risk factors isn’t enough to improve health behaviors, supporting recent primary prevention guidelines that emphasize the role of cognitive-behavioral strategies, multidisciplinary approaches and evaluation of social determinants of health in treating patients.

“Initiation of antihypertensive or statin therapy appears to be associated with lifestyle changes, some positive and others negative,” the authors wrote. “This means that expansion of pharmacologic interventions toward populations at low CVD risk may not necessarily lead to expected benefits at the population level. More effective measures are needed to support the recommended lifestyle change in relation to the initiation of pharmacologic interventions for primary prevention.”

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