Durham, NC—Many patients who could benefit from taking statins have never been prescribed them, and a significant percentage of those who were offered or who initiated the cholesterol-lowering drugs don’t take them now because of side effects or the fear of side effects.

That’s according to a new report in the Journal of the American Heart Association. Duke Clinical Research Institute investigators decried the trends, citing national guidelines indicating that statins can lower risk of heart attack and stroke.

Guidelines from the American Heart Association/American College of Cardiology recommend that clinicians employ an atherosclerotic and cardiovascular disease risk calculator to give a detailed assessment of a person’s 10-year risk for heart disease and to help create a personalized plan, the researchers point out.

“We need to focus our efforts on improving how doctors identify patients who need to be on a statin, and how they present information to patients to ensure that no one is missing the opportunity to improve their heart health,” explained lead author Corey Bradley, MD.

The study sought to find out from patients why they underutilized statins, including noninitiation, refusal, and discontinuation. Included in the research were 5,693 adults recommended for statin therapy in the PALM (Patient and Provider Assessment of Lipid Management) registry.

Overall, 26.5% of the patients were not currently taking the drugs. Patient surveys were used to evaluate statin experience, reasons for declining or discontinuing statins, and beliefs about statins and cardiovascular disease risk.

Of those not on a statin, 59.2% reported never being offered a prescription; 10.1% declined a statin; and 30.7% had discontinued therapy. Results indicate that women (relative risk, 1.22): black adults (relative risk, 1.48): and those without insurance (relative risk, 1.38) were most likely to report never being offered a statin.

The most common reasons cited for declining or discontinuing statins were fear of side effects and perceived side effects. The study also reported the following responses:
• Compared with statin users, those who declined or discontinued statins were less likely to believe statins are safe (70.4% of current users vs. 36.9% of those who declined and 37.4% of those who discontinued) or effective (86.3%, 67.4%, and 69.1%, respectively).
• Willingness to take a statin was high; 67.7% of those never offered and 59.7% of patients who discontinued a statin would consider initiating or retrying a statin.

“More than half of patients eligible for statin therapy but not on treatment reported never being offered one by their doctor,” the study authors emphasized. “Concern about side effects was the leading reason for statin refusal or discontinuation. Many patients were willing to reconsider statin therapy if offered.”

“It is possible that some people did not remember being offered a statin, so we may have over-estimated the percent who were never offered one. However, we believe that if the patient did not remember the conversation, the discussion likely was not an effective one,” Bradley said.

Senior author Ann Marie Navar, MD, PhD, assistant professor of Medicine at the Duke Clinical Research Institute, suggested, “Although there are risks associated with statins, the public fear of side effects is out of proportion to the actual risks. Misconceptions about statins are everywhere and are fueled by false information on the internet. We need better tools to help combat this type of misinformation.”

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