Roughly one third of U.S. adults should be on cholesterol-lowering drugs, according to current guidelines, but almost half of these people aren’t taking the medications, a recent study finds.
More than 78 million people aged 21 and older have high enough levels of low-density lipoprotein (LDL) - the bad kind of cholesterol that builds up in blood vessels and can lead to blood clots and heart attacks - to be eligible for LDL-lowering drugs known as statins, researchers from the U.S. Centers for Disease Control and Prevention (CDC) note in the Morbidity and Mortality Weekly Report.
But overall, only about 56 percent of people who might benefit from the drugs took them. Women eligible for treatment did better than men – about 59 percent of them were taking the drugs compared with 53 percent of their male peers.
“Making lifestyle modifications such as exercising and adopting a healthy diet and taking the appropriate medication can be extremely effective in lowering your cholesterol and ultimately reducing your risk of a heart attack or stroke,” lead report author Carla Mercado of CDC said by email.
The snapshot of cholesterol drug usage from 2005 to 2012 offers fresh insight into how many individuals, and what types of patients, might be less likely to be on statins under expanded treatment guidelines for the drugs issued in 2013, Mercado said.
That year, U.S. cardiology groups recommended expanding use of statins to include certain people without a history of heart disease who had some signs they might be at risk for complications like heart attacks in the future – including obesity, smoking, high blood pressure, diabetes, high cholesterol and older age.
“It’s not surprising that we would find people not taking medication who are now eligible,” Mercado said.
Mercado and colleagues reviewed nationally representative survey data for more than 3,700 adults and about 47 percent of participants reported making lifestyle modifications such as exercising more, altering their diet or controlling their weight.
Roughly 37 percent of people surveyed reported both taking statins and making lifestyle changes. But 36 percent reported doing neither.
Among adults eligible for treatment, whites were more likely to take statins than Hispanic or black patients.
In addition, poor people and individuals without a college degree were less likely to take statins than university graduates and more affluent people.
About 60 percent of obese people took statins, as did roughly 63 percent of people with either diabetes or high blood pressure.
Limitations of the study include the potential that it underestimated the number of adults eligible for treatment because it excluded nursing home residents, the authors concede.
It’s also possible, though, that using the broader eligibility guidelines issued in 2013 might have overestimated the number of people who needed cholesterol medication.
As many as 10 percent of patients may get muscle aches from statins, a side effect that can discourage them from continuing treatment for a condition like high cholesterol that doesn’t come with obvious symptoms patients can feel, said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic in Ohio.
“If they get muscle aches and remember that they are taking the drug for an asymptomatic disease, maybe they are going to stop taking the drug,” said Nissen, who wasn’t involved in the study.
“High cholesterol has no symptoms – it’s not like a headache or a stomach ache or feeling bad – it is just a risk factor,” Nissen added.
In addition, some cardiologists believe the 2013 guidelines may have recommended treatment for too many people, particularly by suggesting some healthy individuals take drugs based on an estimated future risk of developing cardiovascular disease. The new guidelines may have roughly doubled the number of people eligible for treatment.
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