TUESDAY, July 23, 2002 (HealthDayNews) -- With the persistence of children who just won't do what's good for them, older people aren't taking the cholesterol-lowering statin drugs that have been proven to help prevent heart attacks and stroke.
It's not a matter of money, because the seniors could get the drugs at little or no cost, say two reports in tomorrow's Journal of the American Medical Association. While there is no overriding explanation, part of the problem seems to be that it takes a clear and present danger to make people of any age swallow their medicine.
"People who had a heart attack the previous year were more likely to take the medication," explains Cynthia A. Jackevicius, an adjunct scientist in the health policy management and evaluation department of Toronto General Hospital, whose study looked at people 66 and older who were in the Ontario province drug plan.
Her numbers were remarkably similar to those of one that included people in the New Jersey Medicaid program.
"It's striking how alike they are. We must have it right, " says Joshua S. Benner, who led the study when he was at Brigham and Women's Hospital in Boston.
In the New Jersey study, 40 percent of those prescribed a statin stopped taking the recommended doses within three months. The noncompliance rate rose to 61 percent after a year and 68 percent after 10 years.
In the Canadian study, the dropout rate was 25 percent in the first three months after a prescription was written. Nearly 75 percent of those who had dangerously high cholesterol levels but no active heart disease stopped taking the medications after two years. The two-year compliance record was a little better for people with active heart disease, with a dropout rate of nearly 60 percent for those diagnosed with acute coronary syndrome and 64 percent for people with coronary artery disease.
"If I had to guess why people stop, I would say that they don't understand that their condition requires long-term treatment," Benner says.
"Other studies have postulated that having high cholesterol levels is like having high blood pressure," Jackevicius says. "You can't feel it and because of this, it is not obvious that you need to treat it."
Both researchers say their studies are not designed to suggest ways to improve the situation, but both have some ideas.
"Education is a big first step," Benner says. "People need to understand why and how long they need to take the medication to benefit from it." Compliance seems to improve when there are published reports of trials showing the benefits of statins, he says, and both doctors and pharmacists could try to get the message across.
"Because there is a high early dropout rate, the important thing is that when a patient comes in to fill the first prescription, the pharmacists can spend some time explaining the benefits," Benner says. "Other things, like reminders, could be effective -- postcards to patients when refills are due, but nothing takes the place of education with a trusted health professional."
Jackevicius says doctors and pharmacists should take advantage of the "teachable moment," when someone is released from the hospital, to emphasize the importance of taking the drugs.
The new reports can help by publicizing the issue, says Dr. William B. Applegate, dean of the Wake Forest University School of Medicine and author of an accompanying editorial, but "just reporting is not enough."
"There are several possibilities," he says. "We need to do a better job in terms of health management in general. Second, it has been shown that nurse-run health plans, where they go over measures with patients, show higher rates of compliance with preventive medications."
Setting up databases of persons who have been prescribed the drugs is another possibility, Applegate says: "We wouldn't want to invade their privacy, but we could provide useful advice."
What To Do
You can learn about high cholesterol and why it should be lowered from the American Heart Association or the National Heart, Lung, and Blood Institute.
