The Cost of Not Taking Your Medication

I was cleaning off my desk recently, and came across a journal article that had caught my eye a few months ago. The research study looked at the question of what happens to people who have a cardiac event (heart attack, stent, bypass surgery), and then don’t (or can’t) take their cholesterol medication regularly. 

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Lowering cholesterol through the use of “statins” is the cornerstone of heart disease treatment, and has been for decades. Many published research trials have shown an average of ~20% reduction of major cardiovascular events for each 40 point drop in someone’s LDL-C (“bad cholesterol”). And greater benefits are achieved with larger reductions in LDL cholesterol levels: Drop your LDL by 80 mg/dL, and your risk of a repeat event goes down by 40%. 

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And the effect is very long-lasting. In one famous research trial called WOSCOPS, over 6000 patients were randomized to Pravastatin 40mg. The trial ran for 5 years, and when it was published in 1995, it revealed a benefit for the people who had been on the statin: a 31% reduction in the risk of cardiac events. But the even more interesting thing is that in 2016, the researchers took another look at this same group of people, and the ones in the original statin arm of the trial still had a 21% lower risk of dying from heart disease, and a 13% lower risk of dying from any cause. Simply because they took a statin for 5 years twenty years earlier!

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Lots of research studies have shown that the benefits of being on cholesterol medication increase with increased duration of treatment, which in plain english means: the longer you take it, the more benefit you get.

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Unfortunately, research shows that only 30% of people are still taking their statin two years after having an event. There are many reasons for this, including the self-perceived side effects of statins on cognition, muscle discomfort and the concern for the development of diabetes. Others simply don’t want to take prescription medications or are suspicious of “big pharma”. There is a powerful negative bias against statins in the culture, and as a result many people stop taking their medication.

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In this recent study, the authors asked the question: What happens if you don’t take your medication after an event regardless of the reason, and what happens if you don’t achieve your cholesterol targets as a result? 

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The researchers evaluated a group of people with premature heart disease (premature defined as men <50 years old and women <55 years) that had bypass surgery, angioplasty/stent or who had blockages that were not severe enough to require fixing.  The authors of this study looked at pharmacy records and cholesterol levels to see if there was a difference in outcomes based on whether or not people took their medication and also whether or not they achieved their cholesterol goals. 

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The study revealed that only 39% of these patients had achieved their target cholesterol level 1 year after their initial event, and this actually worsened over time (only 31% reaching their goal at 2 years, 27% at 3 years). In fact, 27% of the patients were never at target cholesterol during the entire three years. And only 43.5% of patients were still continuously taking their statin by three years after their event. 

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Predictably, this study showed that the patients who had stopped their statins and had worse long term cholesterol control had DOUBLE the risk of a repeat event, as compared to patients who took their medication regularly and achieved their cholesterol targets/goals. 

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If you have heart disease or if you’ve already had a cardiac event, then medication is a very important tool that you can use to help prevent a future heart attack or stroke. Statins are safe and effective, but they are not for everyone. There are patients who have real side effects that affect their quality of life. 

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So what happens if you can’t tolerate certain medications? This research shows that if you don’t do anything about your cholesterol, your risk of a repeat event doubles. The good news is that at this point in medical history, there are lots of things you can use to lower your cholesterol. Moving to a more plant-based diet can lower your cholesterol, and there are now plenty of non-statin cholesterol medications in our “toolbox” that can help you achieve your goals. In 1995, when WOSCOPS was initially published, statins were the only medication out there with proven ability to lower risk of heart attack. Fortunately, now there is a wide range of options from which to choose.

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At Wisconsin Cardiology Associates, we have specialized and advanced training in cholesterol management.

‍If you need to be on cholesterol medication, come for a consultation and we can help you find the best option for your situation.

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References:

Vikulova DN et al. JACC Adv. 2023 Dec, 2 (10) 100696

Ford I et al. Circulation. 2016;133:1073–1080

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Photo by Anastasiia Gudantova on Unsplash

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