Heart Pills Often Taken Incompletely
People 65 and older often stop taking their statin heart medications far too soon, setting themselves up for potentially fatal cardiovascular problems, researchers reported in two studies released recently.
Statins include some of the best-known medications, such as Lipitor, Mevacor, Pravachol and Zocor. The drugs lower cholesterol and protect the heart after an attack.
But these patients aren’t taking their medications over the long haul. Prescriptions are written, said researchers in the Journal of the American Medical Assn., but patients do not always refill them. For many older people, doctors say, statins should be taken for life. Stopping the medications, studies have shown, can trigger a rebound effect, causing some problems to return in more severe forms.
The telltale issue of noncompliance comes from a study of more than 34,000 New Jersey heart patients. Scientists at Brigham and Women’s Hospital in Boston, led by researcher Joshua Benner, used the databanks of New Jersey Medicaid and the Pharmaceutical Assistance to the Aged Programs.
“We looked at the percent of days they had the drugs available,” Benner said of having a filled statin prescription in the house.
“Every time a patient went to a pharmacy,” Benner said of getting a refill, “they received credit for that many days of medication. So we assumed they took the medication they received.” Mathematically, Benner, who is now director of health economics with Epinomics Research Inc., in Alexandria, Va., developed a measure called the PDC, shorthand for “proportion of days covered,” or how many days’ worth of medication patients had on hand.
Compliance declined by 25% in the first six months of therapy. By the fifth year of treatment only one in four patients had a PDC of 80%. The abysmal lack of compliance was not the result of doctors’ having failed to write the prescriptions, Benner said, because researchers tracked how many prescriptions patients got.
He doubts the compliance problem is related to side effects, because problems with statins are mild. A second study in the journal, by Cynthia Jackevecius and colleagues in Canada, showed a similar statin compliance problem. Her study included patients who had heart attacks in the previous year, along with those suffering chronic heart disease.
The drugs work by slowing the liver’s production of cholesterol and by increasing the organ’s ability to remove LDL, the so-called bad form of cholesterol, from the blood. The drugs are best taken during the evening, because the body makes more cholesterol at night than during the day.
