Do you take any medications? Or supplements? I do. Perhaps supplements is a post for another time, but I do want to mention something on medication. I take a nasal steroid spray, and have done daily for about 12 years. Truth be told I really should have been on it lifelong, as I have had troublesome nasal polyps. By troublesome, I mean I have had 4 surgeries to remove them (first one aged 11!), and I can tell you it isn’t pleasant. The pain is pretty extraordinary, particularly the one when I bled afterwards. The last operation was 12 years ago, and that was the point when I decided enough was enough and I would have the medicine. So far so good, no more operations as yet.
Why do I mention this? The term doctors use to assess whether patients take medications as prescribed is compliance. I had 0% until 12 years ago, and I would say now 99%. And that’s to prevent some polyps in my nose! At the European Society of Cardiology I learnt about a few interesting statistics. In one published study of over 600,000 patients (yes that’s 600,000 I didn’t add a 0!) with atherosclerotic heart disease (furring up of the heart arteries), 50% weren’t taking a statin. The factors that meant people were more likely to be on a high-dose statin were male gender, age <56, type 2 diabetes, high blood pressure, and a visit to a cardiologist. Conversely women, age>45, peripheral artery disease and additional co-morbidities all were associated with less statin use.
Now undoubtedly statins often get a bad press, but I found these numbers surprising for a medication that saves lives, prevent strokes and heart attacks (rather than just having a bunged-up nose!). Patients often discontinue them after time also, but unless are seeing at the very least their GP or if not a cardiologist, I can easily see why that might be the case. People need reminding of the benefits, and indeed risks, of any medication they take over time, and regular (if infrequent) tablet reviews help.
I think it also helps if patients can directly see the evidence for the use of a particular medication in their own individual circumstance. If the reason for taking a drug is a notional future benefit, compliance is likely to be poor long term. For example, I find that patients who have had a CT scan of their heart and can actually see a narrowing (even if they are very small) in their arteries are much more likely to take medication, even if they didn’t want to previously.
Having said all this, there are of course patients who simply can’t take statins (around 8% in the real-world big studies). The recent conference had many sessions on the evolving landscape of medications to improve cholesterol. There are a number of non-statin drugs which are excellent options for statin-intolerant patients.
Another surprising statistic was what proportion of patients who have had a heart attack don’t meet the cholesterol target after treatment. What do you think? 10%? 20%?
Nope, nearly three-quarters! We clearly need to do better. Please see the section on cholesterol in the members area to read more on the options.
In this week’s video, I discuss a sham trial. These are rather unusual in cardiology. The idea is to mimic a placebo – a patient in the sham arm ‘thinks’ they have had an intervention such as a stent or ablation, when in fact they were just given sedation, tubes inserted into the heart….but no operation was ever actually performed.
I’ve also added to the successes and challenges area. I’ve written about an improvement I would like to make in my own life. By writing it down, and being accountable to others, the science says I will improve my chances of success.