Statin Side Effects Stymie Compliance
Experiencing side effects such as muscle-related pain or weakness was the top reason why patients stopped taking statins, according to results from a large survey.
Of the 1,220 respondents who stopped taking statins, 62% cited side effects as the main reason, compared with 17% who cited cost and 12% who said the drug lacked efficacy, reported Jerome D. Cohen, MD, from St. Louis University School of Medicine, and colleagues.
Nearly half of the 8,918 survey respondents who were currently on statins but switched brands at some point cited cost (36%), side effects (28%) and lack of efficacy (22%) as the reasons for the switch, researchers wrote online the Journal of Clinical Lipidology.
Muscle pain or weakness was reported by 29% of all survey respondents, but the rate was higher among former users compared with current users (60% versus 25%).
Gaps in cholesterol goal achievement have been attributed to a variety of causes, including medication non-adherence, the authors noted in their introduction. It has been reported that 50% or more of patients discontinue statin medication within 1 year after treatment initiation, and that consistency of use decreases over time, they wrote.
The survey revealed that physicians often suggested switching or discontinuing the drug after conversations about muscle-related side effects. However, about one-third of those surveyed stopped statins on their own, without their doctor’s blessing.
“Medication persistence is a huge problem,” Eliot Brinton, MD, a co-author and spokesman for the National Lipid Association, said in an interview with MedPage Today.
Brinton said that most studies looking at statin compliance and adherence are done in an objective manner, generally by examining prescription records. “This is one of the few subjective studies, and it’s the largest,” he said. “But both types of studies are helpful to gain an overall picture of patient attitudes toward taking statins.”
The Internet-based, self-administered USAGE (Understanding Statin use in America and Gaps in Education) survey involved more than 10,000 current or former statin users and was conducted for a month in 2011. Survey respondents were predominantly Caucasian (92%) and female (61%), with a mean age of 61. Most had health insurance and the median household income was $44,504, which differed significantly between current ($45,270) and former ($39,452) users.
More than three-quarters of current and former users had a body mass index greater than 25 kg/m2. Significantly more current users had hypertension, diabetes, heart disease, and a previous myocardial infarction, which “could account for their better compliance to statin therapy compared with those who stopped taking the drug,” said Brinton, director of atherometabolic research at the Utah Foundation for Biomedical Research in Salt Lake City.
Significantly more former users had arthritis, depression, gastroesophageal reflux, osteopenia, and osteoporosis.
Less than half of all respondents couldn’t recall their most recent cholesterol level. However, of those who could, more were current users. Also, women were less likely than men to know their cholesterol profiles.
“Physician-patient communication is particularly important for medication compliance,” Brinton said.”When patients are aware of their cholesterol levels and goals, they are more likely to adhere to their statins.”
Brinton noted that a majority of respondents (81%) cited their doctors as an important source of medical information. However, former statin users were less satisfied with their physician’s cholesterol management compared with current users.
Also, nearly half of respondents who were taking supplements believed their pharmacist would alert them to potential interactions with statins.
Although most of those surveyed adhered to cholesterol monitoring, those who did not cited inconvenience (27% among former users and 18% among current users), cost (21% versus 8%), and a belief that their cholesterol was under control (16% versus 13%).
Overall, however, current statin users had “excellent adherence” to daily statin use, and a majority of all respondents were satisfied with their physician’s cholesterol management, the survey found.
But the benefits of statins depend on their long-term use and the results of this survey suggest “that more effective dialogue between healthcare providers and patients may help increase adherence and persistence of statin use, particularly when the patient has concerns about drug side effects and costs,” researchers concluded.
One limitation of the study is that it may not represent the overall population of the U.S., researchers said. Also, the study is limited by the potential for bias inherent in self-reporting.
The study was funded by Kowa Pharmaceuticals America and Eli Lilly.
Cohen reported he had no conflicts of interest. Brinton reported relationships with Abbott Laboratories, AstraZeneca, Merck, Bristol-Myers Squibb, Daiichi Sankyo, Kaneka Pharma America, Takeda Pharmaceuticals, Kowa Pharmaceuticals, GlaxoSmithKline, Boehringer Ingelheim, LipoScience, Amarin Pharmaceuticals, Health Diagnostics Laboratory, Roche/Genentech, Atherotech, Essentialis, and Arisaph. Other co-authors reported relationships with some of the same companies.
Primary source: Journal of Clinical Lipidology
Source reference: Cohen JD, et al “Understanding Statin Use in America and Gaps in Patient Education (USAGE): An internet-based survey of 10,138 current and former statin users” J Clin Lipid 2012; 6: 208-215.
By Chris Kaiser, Cardiology Editor, MedPage Today