by Aolin Zhang '18
Today, more Americans die from cardiovascular disease than any other cause.
Thus, it’s not surprising that the sale of statins, medications used to prevent and treat heart disease, is among the largest out of all drugs in the U.S. What is surprising, however, is the number of people who actually stick to their statins regimen. Less than 50% of statins users remain committed to their medications after a year and this number steadily decreases with time. Given that statins are long-term drugs, statins non-adherence presents a major health issue. So, what’s happening?
Statins, often advertised as Lipitor or Crestor, prevent and treat atherosclerosis, the accumulation of plaque in arteries and the chief cause of cardiovascular disease. Their primary mechanism of action involves inhibiting liver cholesterol production, thereby reducing cholesterol levels. With fewer cholesterol molecules in the blood, there is less plaque buildup. Since statins’ synthesis in the 1970s, many clinical studies conducted on statins’ efficacy have found that they are capable of reducing cholesterol levels 21% to 63%. Moreover, recent research has demonstrated that statins may have direct effects on atherosclerotic plaque. Given these benefits, why aren’t more people sticking to their statins?
The immediate causes of statins non-compliance are easy to identify: forgetfulness, disregard, etc. The roots of these immediate causes, however, are more difficult to decipher, but can be boiled down to atherosclerosis’ “silent” nature, poor physician-patient interactions, and worries regarding statins’ actions.
Atherosclerosis is largely asymptomatic. During most of its development, the buildup of plaque does not manifest itself in any serious discomfort and so, in effect, a person “feels nothing.” Consequently, many statins users do not experience immediate relief from taking statins as they do from taking, say, aspirin for headaches. This lack of perceptible effects leaves users dubious of statins’ utility. As a result, they become more likely to ignore their regimen.
Good physician-patient interactions are essential for helping patients understand and accept the treatments they must undergo. In today’s world, however, with healthcare’s emphasis on efficiency, good physician-patient interactions are hard to come by. When doctors prescribe statins, many times they cannot fully explain statins’ mechanism of action. These inadequate interactions generate in patients’ uncertainty about statins’ efficacy.
Statins – like all other medications – have side effects, which include constipation and rash. While these side effects are certainly harmful, they are greatly outweighed by statins’ life-saving benefits. Nevertheless, there exist a number of statins opponents who refuse to acknowledge these pros, choosing only to see their drawbacks and exaggerate them through influential media. When users are confronted with such negative opinions, they become scared. As one user puts: “You hear this stuff and say, ‘Gee, am I killing myself?’”
The price of statins non-adherence is high and multi-dimensional: When a user chooses to end her statins regimen, she has a 10% to 40% greater chance of developing cardiovascular issues. Additionally, she faces on average $453 in costs for the treatment of statins discontinuation-associated illnesses.
Fortunately, these consequences are not indelible. They can be reversed by returning to one’s statins regimen. So how can this be accomplished? Or better yet, how can non-adherence be prevented in the first place?
S.I.M.P.L.E. holds promise for delivering such a fix. S.I.M.P.L.E aims to cut non-adherence by Simplifying regimens, Imparting knowledge, Modifying patient beliefs, Providing communication, Leaving bias, and Evaluating adherence. S.I.M.P.L.E. offers a number of important counter-non-adherence measures for each initiative.
One such measure is implementing a one-pill-per-day regimen. Medication frequency and dosing are strong determinants of adherence. Excessively frequent, high-pill-count regimens create inconvenience. Infrequent, low-pill-count schedules make patients neglectful. One-pill-per-day is the optimal regimen between these two extremes that patients will least likely ignore.
Another recommendation is establishing a medication support network. Normally, a medication regimen involves only two people: the physician and the patient. A support network opens this relationship up to family members and other medical professionals. They can help hold patients accountable for their regimens and deliver medication reminders, greatly motivating users to stick to their pills.
Statins non-adherence is complex issue whose solution requires the involvement of physicians, hospitals, and statins users. Despite the difficulty, non-adherence must be fixed for heart disease is claiming thousands of American lives every year. It’s time to commit.