More than 78 million people aged 21 and older have high enough
levels of low-density lipoprotein (LDL) - the bad kind of
cholesterol that builds up in blood vessels and can lead to blood
clots and heart attacks - to be eligible for LDL-lowering drugs
known as statins, researchers from the U.S. Centers for Disease
Control and Prevention (CDC) note in the Morbidity and Mortality
Weekly Report.
But overall, only about 56 percent of people who might benefit from
the drugs took them. Women eligible for treatment did better than
men – about 59 percent of them were taking the drugs compared with
53 percent of their male peers.
“Making lifestyle modifications such as exercising and adopting a
healthy diet and taking the appropriate medication can be extremely
effective in lowering your cholesterol and ultimately reducing your
risk of a heart attack or stroke,” lead report author Carla Mercado
of CDC said by email.
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The snapshot of cholesterol drug usage from 2005 to 2012 offers
fresh insight into how many individuals, and what types of patients,
might be less likely to be on statins under expanded treatment
guidelines for the drugs issued in 2013, Mercado said.
That year, U.S. cardiology groups recommended expanding use of
statins to include certain people without a history of heart disease
who had some signs they might be at risk for complications like
heart attacks in the future – including obesity, smoking, high blood
pressure, diabetes, high cholesterol and older age.
“It’s not surprising that we would find people not taking medication
who are now eligible,” Mercado said.
Mercado and colleagues reviewed nationally representative survey
data for more than 3,700 adults and about 47 percent of participants
reported making lifestyle modifications such as exercising more,
altering their diet or controlling their weight.
Roughly 37 percent of people surveyed reported both taking statins
and making lifestyle changes. But 36 percent reported doing neither.
Among adults eligible for treatment, whites were more likely to take
statins than Hispanic or black patients.
In addition, poor people and individuals without a college degree
were less likely to take statins than university graduates and more
affluent people.
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About 60 percent of obese people took statins, as did roughly 63
percent of people with either diabetes or high blood pressure.
Limitations of the study include the potential that it
underestimated the number of adults eligible for treatment because
it excluded nursing home residents, the authors concede. It’s also
possible, though, that using the broader eligibility guidelines
issued in 2013 might have overestimated the number of people who
needed cholesterol medication.
As many as 10 percent of patients may get muscle aches from statins,
a side effect that can discourage them from continuing treatment for
a condition like high cholesterol that doesn’t come with obvious
symptoms patients can feel, said Dr. Steven Nissen, chair of
cardiovascular medicine at the Cleveland Clinic in Ohio.
“If they get muscle aches and remember that they are taking the drug
for an asymptomatic disease, maybe they are going to stop taking the
drug,” said Nissen, who wasn’t involved in the study.
“High cholesterol has no symptoms – it’s not like a headache or a
stomach ache or feeling bad – it is just a risk factor,” Nissen
added.
In addition, some cardiologists believe the 2013 guidelines may have
recommended treatment for too many people, particularly by
suggesting some healthy individuals take drugs based on an estimated
future risk of developing cardiovascular disease. The new guidelines
may have roughly doubled the number of people eligible for
treatment.
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“There has been a lot of controversy,” Nissen said.
SOURCE: http://1.usa.gov/1m7lDhk MMWR, online December 4, 2015.
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