According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death worldwide, and someone dies every 34 seconds in the United States. A new study by researchers at Brigham and Women’s Hospital, one of the founders of Mass General Brigham’s healthcare system, conducted the first population-based study of patients’ failure to accept statin therapy recommendations.
The study found that among patients at high risk of developing cardiovascular disease, more than 20 percent refused to take statin medications. They were especially surprised to see that women were about 20 percent more likely than men to refuse statin therapy when it was first suggested by their doctor, and 50 percent more likely than men to never accept the recommendation. The study also showed that all patients who refused statin therapy developed higher LDL (“bad”) cholesterol levels, likely increasing their risk even further. The results are published in JAMA network opened.
“Our study highlights the alarming number of patients who refuse statins and indicates that physicians should have discussions with patients about why,” said Alex Turchin, MD, MS, an associate professor at Harvard Medical School and director of quality in Brigham’s Division of Endocrinology. diabetes and hypertension. “We need to better understand our patients’ preferences and be able to provide more patient-centered care.”
After Turchin began noticing that many of his patients with high cholesterol, including those with diabetes, chose not to take safe and beneficial medications, such as statins that can lower cholesterol and reduce the risk of heart attack and stroke, he developed a system to more accurately study the phenomenon by analyzing the text of providers’ notes.
The study focused on high-risk patients who had had coronary artery or vascular disease, diabetes, very high cholesterol or a stroke. All were on statin medications recommended by their doctors to reduce their risk of heart attack and stroke and lower cholesterol levels. The retrospective study included more than 24,000 patients seen at Mass General Brigham between January 1, 2000 and December 31, 2018.
“Even in this higher-risk patient population, so many people were not accepting statin therapy,” Turchin said. The study found that about two-thirds of patients who were recommended statin therapy eventually tried it, but about one-third never did. And it took three times as long for people in the study who initially said no to taking statin medications to lower their LDL cholesterol levels to less than 100, compared to people who initially said yes.
The biggest surprise of the study, however, was the much higher refusal rate among women than among men. Turchin and his colleagues wonder whether this may be due in part to an erroneous misconception that heart disease affects men more than women, and plan to further investigate the reasons underlying these results.
“Ultimately, we need to talk to our patients and find out in more detail why they prefer not to take statins,” says Turchin. He is currently looking at the consequences of not accepting statin therapy on outcomes that matter most to patients, including heart attacks, strokes and death. “I think people underestimate how much of a difference modern medicine has made in extending people’s lives and their quality of life, and medicine can play a big part in that.”
Brigham and the Women’s Hospital
brown, C., et al. (2023) Association of sex differences in non-acceptance of statin therapy and low-density lipoprotein cholesterol levels in patients at high cardiovascular risk. JAMA network opened. doi.org/10.1001/jamanetworkopen.2023.1047.