More than 20% of patients at high risk for CVD reject statin therapy

Many patients at risk for CVD, particularly women, did not accept statin therapy recommended to them by their health care provider, data show.

Researchers said these patients had higher levels of LDL cholesterol, “potentially translating into an increased incidence of cardiovascular events.”

C. Justin Brown, PharmD, of Brigham and Women’s Hospital, and colleagues wrote in JAMA Network Open that “the reasons for the lack of statin therapy among patients at high cardiovascular risk and for the persistent sex disparity are not fully understood and are likely multifactorial.”

“One possible reason for the lack of recommended therapy that has recently come to light is nonacceptance of clinicians’ treatment recommendations by patients,” they wrote. “Anecdotal evidence and patient surveys suggest that this phenomenon is also associated with the lack of indicated statin therapy, but there is a dearth of population-based studies on the subject.”

The researchers conducted a retrospective cohort study from January 2019 to December 2022 to identify trends in statin therapy acceptance among 24,212 statin-naive patients with atherosclerotic CVD, diabetes or LDL cholesterol levels of 190 mg/dL or greater. The patients had a mean age of 58 years and 50.8% were women.

Overall, 21.9% of patients rejected statin therapy. Of those, nonacceptance was more frequent among women compared with men (24.1% vs. 19.7%).

Brown and colleagues found that patients who accepted statin therapy recommendations had a LDL cholesterol level of less than 100 mg/dl after a median of 1.5 years compared with 4.4 years for those who did not.

Nonacceptance continued to be linked to a longer time of achieving an LDL cholesterol level of less than 100 mg/dl in a multivariable analysis that was adjusted for demographics and comorbidities (HR = 0.57; 95% CI, 0.55-0.6).

The researchers highlighted that nonacceptance is different from nonadherence of therapy, with the decisions of patients in the former scenario potentially resulting from an absence of appropriate actions by physicians.

“This study demonstrates that patients are active agents in their care, and their preferences and priorities should be carefully taken into account when making treatment recommendations,” they wrote.

Brown and colleagues also noted that the association between therapy acceptance and lower LDL cholesterol is “not as self-evident as it may seem because patients’ cholesterol levels may have been associated with many other factors.”

“On the one hand, a patient’s initial acceptance of statin therapy does not necessarily guarantee continuous use of the statin, or even any use at all, because patients can often be nonadherent to statins,” they wrote. “On the other hand, a patient’s initial nonacceptance does not necessarily indicate that the patient will never take a statin — nearly two-thirds of patients who initially did not accept a statin did eventually start taking statins, which may have occurred shortly after their initial nonacceptance.”

The researchers concluded that “further research is needed to identify the reasons why patients do not accept statin therapy recommendations and the reasons for the higher rates of this important clinical phenomenon among women.”

References:

• Brown C, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.1047.
• Study finds 1-in-5 patients at high risk of cardiovascular disease refuse statin therapy. https://www.newswise.com/articles/study-finds-1-in-5-patients-at-high-risk-of-cardiovascular-disease-refuse-statin-therapy?sc=dwhr&xy=10017350. Published Feb. 27, 2023. Accessed March 3, 2023.