Physicians fail to offer statins to eligible patients, study says

More than half of eligible American adults who are not on a cholesterol-lowering medication, or statin, say it’s because their physician did not offer the option, according to new research.

Researchers surveyed 5,693 people from the Patient and Provider Assessment of Lipid Management Registry, a national database of doctor practices across the United States. A total of 1,511 of the adults were not receiving treatment with a statin, despite meeting eligibility criteria for the medication according to 2013 American College of Cardiology and American Heart Association guidelines.

A majority — 59% — of those 1,511 cited the fact that their physician never offered the medication. Ten percent reported declining statins after their physician recommended them, and 30.7% had taken a statin but had chosen to stop, according to the study, published Wednesday in the Journal of the American Heart Association.

Those who say they were never offered a statin were more likely to be women, African-American and uninsured, according to the study.

Statins work by lowering the amount of “bad” cholesterol, known as low-density lipoprotein or LDL. Because the drugs can lower the risk of heart attacks and strokes, the American Heart Association and the American College of Cardiology recommend that doctors use a 10-year risk calculator to determine which patients may benefit from such therapy.

Over 78 million Americans, or just over a third of all adults, are eligible for statin therapy or are already taking a statin, according to the US Centers for Disease Control and Prevention.

“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,” said Dr. Corey Bradley, lead author of the study and a researcher at the Duke Clinical Research Institute in Durham, North Carolina, in a statement.

Among those who were offered a statin but declined, the most common reason was fear of side effects.

“Although there are risks associated with statins, the public fear of side effects is out of proportion to the actual risks,” said Dr. Ann Marie Navar, senior author of the study and assistant professor of medicine at the Duke Clinical Research Institutem in a statement. “Misconceptions about statins are everywhere and are fueled by false information on the internet.”

Weighing the risks and benefits of a lifelong medication like statins is important, says Dr. Amit Khera, director of the UT Southwestern Medical Center’s Preventive Cardiology Program, who was not involved in the study.

When Khera counsels his own patients about statins, the three side effects they most commonly ask about are muscle aches, changes in cognitive function and liver function.

“Statins can cause muscle aches, but even if it’s as high as one in 10 who get muscle aches, that means 9 in 10 will not. For the vast majority, that won’t happen, and it generally goes away when we stop the statin,” Khera said.

As for concerns about cognitive decline, “it is not something seen in large studies, so if it does occur, it is infrequent and hard to separate from the usual cognitive decline of aging,” he said.

Additionally, “we realized over time that minor increases in liver function tests are not clinically significant, as statins very rarely cause serious liver damage for patients,” he said.

The authors acknowledge that the new study had several limitations. Because it included patients who were part of a national registry and were potentially eligible for statin therapy, they believe that the results may underestimate the number of people who go without receiving statins.

With a survey study, the team acknowledges, the results are subject to recall bias, meaning patients who ultimately started taking a statin were more likely to remember it being offered to them.

“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.