Confidence in statins key to adherence, say researchers

Confidence in the efficacy of statins to minimise the risk of life-threatening cardiovascular disease (CVD) facilitates their uptake, concludes an analysis of data from nearly 900 patients.

The systematic review of 32 qualitative studies, published in the British Journal of General Practice (online, 22 May 2018)^[1]
, looked at data from across 8 countries and identified 7 key themes: confidence in prevention, routinising into daily life, questioning utility, medical distrust, threatening health, signifying sickness, and financial strain.

Some patients were found to be concerned about the potential adverse effects of statins on their physical and mental health, and were reluctant to be dependent on long-term medications. The pharmacological mechanisms and benefits of statins were also considered to be unclear to some patients and were therefore the reason for some deciding to discontinue their medications.

Other patients said that they were suspicious about their clinician’s motivations for prescribing statins and felt under pressure to start statin therapy. While some were sceptical about the overprescribing of statins, which the authors said could be driven by media coverage of the Quality and Outcomes Framework (QOF), which introduced incentivised prescription of statins to promote wider use of the medication.

The researchers did find some differences in patient perspectives depending on their individual characteristics. For example, older patients were found to be particularly grateful for statins, due to the fact that preventive measures for CVD were not readily available until recent decades.

Patients with a family or personal history of CVD were also seen to be more convinced of the benefits of taking statins, and were more likely to tolerate side effects and be diligent about taking their medication.

For those already taking medications for other conditions, such as type 2 diabetes, statins were found to be of lower priority than their other medicines.

“It’s understandable that patients have concerns about the benefits and risks of taking statins, given the controversy that has surrounded them in the media, and the diverging views that exist around statins amongst healthcare professionals,” said Helen Stokes-Lampard, chair of the Royal College of GPs.

“Patients certainly have the right to question whether statins are the best course of treatment for them — as they do with any medication they are prescribed — and this should be part of a conversation between doctor and patient about all the potential risks and benefits to their health and wellbeing.”

The authors of the study concluded that shared decision-making that addresses the risks, reasons for prescribing, patient priorities and implementing strategies to minimise lifestyle intrusion and manage side effects could help to improve patient satisfaction and continuation of statins.