Many patients who would clearly benefit by lowered LDL cholesterol levels are choosing to forgo first-time recommendations for statin regimens, according to a population-level study conducted at Brigham and Women’s Hospital in Boston and published Feb. 28 in JAMA Network Open [1].
The research followed more than 24,000 adults at heightened risk of a cardiovascular event due to high LDL levels and/or other factors.
A substantial proportion of the cohort received an initial recommendation to begin statins in a primary care setting, replicating the circumstances of most patients with hypercholesterolemia in the U.S., the authors point out.
To conduct the study, corresponding author Alexander Turchin, MD, and colleagues reviewed medical records of patients treated over an 18-year period at their institution who had never taken statins despite having known atherosclerotic cardiovascular disease, diabetes or LDL cholesterol levels of 190 mg/dL or higher.
Homing in on sex disparities in adherence to clinician recommendations for statin therapy, the team found women significantly more likely than men to decline the advice (24.1% vs. 19.7%).
Meanwhile, among all patients who did follow doctors’ statin recommendations, LDL cholesterol levels dipped below 100 mg/dL—the optimal maximum for individuals with elevated cardiovascular risk—in a median time of 1.5 years.
By comparison, it took recommendation rejectors a median of 4.4 years to achieve that goal.
In their discussion, Turchin and co-authors note that nonacceptance of statin therapy recommendations is in many ways distinct from the more widely studied phenomenon of statin nonadherence. They write:
Unlike medication nonadherence, which is often due to high medication costs or adverse reactions the patient developed, nonacceptance of treatment recommendations takes place before the patient has had any direct experience with the medication; the reasons for it are therefore likely to be different. … 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.”
Underscoring the gap in lowered LDL cholesterol between statin recommendation followers and non-followers, Turchin and colleagues call for further research into ways for ensuring that patients receive optimal therapy “in accordance with their preferences and priorities.”
Also of note, Turchin et al. used natural language processing technology, a discrete branch of AI, to identify patients who rejected statin therapy recommendations from physicians.
The authors state that, because their study is the first to investigate statin nonacceptance at population scale, the AI aspect of the project “highlights the potential for the use of artificial intelligence technology in combination with vast data sets to make novel research questions accessible for investigation for the first time.”
Read the full study here.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.