Heart disease patients who undergo surgery may be less likely to stick with their cholesterol medication than those treated with drugs alone, a new study finds.
Research has shown that people with heart disease commonly skip doses of their cholesterol-lowering statin medication, or stop taking the drugs altogether.
These latest findings, researchers say, suggest that heart-surgery patients are particularly likely to do so. Skipping doses or stopping statins altogether is a serious concern, according to the authors, because the drugs have been shown to cut the risk of repeat heart attacks and improve long-term survival.
“Truthfully, we were quite surprised by the finding,” said senior researcher Dr. Niteesh K. Choudhry, of Brigham and Women’s Hospital and Harvard Medical School in Boston.
Going into the study, he and his colleagues had expected to see that surgery patients would be more likely to stick with their statins than people with heart disease being managed with medications only.
Having surgery, particularly heart bypass surgery, can be a “life-altering event,” Choudhry said in an interview. So you might expect, he said, that surgery patients would be especially careful to follow their heart-drug regimen.
But that seemed not to be the case.
The study, reported in the American Journal of Cardiology, looked at Medicare data on more than 13,000 older adults who were hospitalized for a heart attack or severe chest pain caused by diseased heart arteries.
More than 9,400 were treated with heart bypass surgery or angioplasty, where blockages were cleared from the heart arteries and stents were implanted to help keep the arteries open. The rest of the patients received only medication – including blood pressure drugs, blood thinners and drugs to control heart rate.
All of the study patients, including surgery patients, were prescribed a statin. Such drugs can cost anywhere from $11 to $200 per month, according to Consumer Reports.
Overall, Choudhry’s team found, 70 percent of the surgery patients fully adhered to their statin prescription for a year. That compared with 79 percent of the medication-only patients.
Nearly all people with serious heart disease like those in the current study would be candidates for statin therapy, Choudhry said.
It’s not clear why surgery patients were less likely to take their statins, Choudhry said. But one possibility is that they were less likely than medication-only patients to have ongoing problems with chest pain. Without that symptom, some might think their medications are unneeded.
“They might think, ‘I underwent this procedure, and now I’m fixed,'” Choudhry said.
However, he added, the reasons that any one person might skip his statin are many.
Cost could be one, Choudhry said. Even with Medicare, an older adult on several medications may not be able to afford all of the co-payments. In other cases, people may stop taking their statins because of side effects, like muscle pain.
According to a recent disclosure in the journal Circulation, Choudhry has been funded by Aetna, CVS Caremark, the Commonwealth Fund, and the Robert Wood Johnson Foundation, and has consulted about appropriate medication use for the Alosa Foundation, a nonprofit that has no relationship to any drug or device manufacturers.
When it comes to serious heart disease, Choudhry said, people are generally prescribed a “cocktail” of medications that are all “critically important.”
“If you’re having trouble taking all of your medications, talk to your doctor about it,” he advised.
People whose statin is causing side effects, Choudhry said, may be able to switch to a lower dose, a different statin, or a different type of cholesterol drug.
SOURCE: American Journal of Cardiology, online March 18, 2011.