Lack of Guidance, Side Effects Keep Patients from Taking Statins

A study of patients recommended for statin therapy under ACC/AHA guidelines, but not taking any, found that 59.2% reported never being offered a statin.

Corey Bradley, MD

A study of patients recommended for statin therapy found that 59.2% of those who weren’t on the treatment reported never being offered a statin by their doctor. Black adults, women, and patients without insurance were most likely to report never having been offered 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,” said Corey Bradley, MD, lead author of the study and a researcher at the Duke Clinical Research Institute in Durham, North Carolina.

The study included the 5693 of 7938 adults in the cross-sectional Patient and Provider Assessment of Lipid Management (PALM) registry who were recommended for statin therapy according to the 2013 American College of Cardiology and American Heart Association guideline. At enrollment, core lab lipid panels were taken, and participants completed a digital survey.

Overall, 26.5% (n = 1511) of patients recommended for statin treatment were not receiving them at that time. Of those, 59.2% (n = 894) reported never having been offered a statin, 30.7% (n = 464) reported having discontinued a statin, and 10.1% (n = 153) reported having received and declined an offer of statin therapy.

Bradley commented that some participants may not have remembered being offered a statin, so the percent of participants who had never received an offer of statin therapy may have been overestimated. “However, we believe that if the patient did not remember the conversation, the discussion likely was not an effective one,” she said.

Compared to patients actively receiving statin therapy, those participants who reported never having been offered statins were more likely to be female (51.1% vs 39.4%, P < .001), black (20.9% vs 12.1%), and Hispanic (14.0% vs 10.1%, P = .0005).

Of the 153 participants who declined statin therapy, 36.8% cited a fear of side effects, 25.0% mentioned a preference to focus on diet or exercise, and 19.4% believed that statins were not necessary. Of patients who discontinued statins, the most commonly given reason for stopping was perceived side effects (55.0%). Just 18.2% of those who discontinued felt that they no longer needed a statin.

“Although there are risks associated with statins, the public fear of side effects is out of proportion to the actual risks,” said Ann Marie Navar, MD, PhD, senior author of the study and assistant professor of Medicine at the Duke Clinical Research Institute. “Misconceptions about statins are everywhere and are fueled by false information on the internet. We need better tools to help combat this type of misinformation.”

Many patients who had never tried a statin or who had discontinued the therapy were still willing to consider statin therapy. Among those who had never been offered a statin, 41.9% were “very likely” or “almost certainly” willing to take a statin, and 25.8% were “possibly” willing to try the therapy. Just 16.7% stated their unwillingness to take a statin. For those who had discontinued statin therapy, 38.4% were “very likely” or “almost certainly” willing and 21.3% were “possibly” willing to take a statin. Only 29.1% were unwilling to retry statin therapy, and 11.2% didn’t know or did not answer.

Investigators discussed the implications of these findings, writing that providers should keep an open conversation with patients regarding the possibility of starting or retrying statin therapy.

“Physicians should not hesitate to re-approach the conversation about starting or re-trying statin therapy in patients who could benefit but are currently not on the therapy,” Bradley said.

The study, “Patient-Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry,” was published in the Journal of the American Heart Association.