STOPPING STATINS & OTHER DRUGS

Answers to your worries about cholesterol lowering drugs

This week I’ve had several patients come in to my office and say that they have missed taking their statins as well as other medications. Patients come in and report that they have had a symptom that they believe is a side effect. They will attribute that side effect to a particular medication and stop it. They do this without discussion and without involving the doctor in that decision-making process.

WHY DOES THIS OCCUR? 1. Some patients will just run out of the medication.

For example, if they have been in hospital and a medication has been started. If that medication lasts for a month only, then when that medication is used up, some patients will believe that they finished the course of therapy that they are required.

2. Some people just forget to take their medication.

That can happen. It’s very hard to focus that

priority. My observation is if someone’s had a heart attack, for example, they are more likely to remember their medication, than, for example, someone who has mildly elevated blood pressure who feels perfectly well and doesn’t like the idea of taking tablets.

3. Some people will read information on social media.

They then make unilateral decisions about what care they should be on without engaging the doctor who prescribed their medication in a conversation about it.

ARE STATINS MORE LIKELY TO BE STOPPED?

Different patients will have a different benefit and statins are a very good example of this. There is no question that any medication including statins run the possibility of some risk to the patient.

1. For statins, a side effect may be muscle aches and pains.

The possibility of a side effect is common for almost any medication whether it’s Panadol, aspirin or even water, too much water could give people a side effect. Well, we have to weigh up the drugs we use against their therapeutic doses and effects. Does the risk of a particular agent balance up or is it outweighed by the benefit it can offer that individual patient?

I believe this is where the conversation needs to be specific to the individual who we’re dealing with.

2. The need for secondary prevention.

In regard to statins, there is no question that in secondary prevention, which means people who’ve had a heart attack or an event like a heart attack, we have clear evidence from multiple studies that lowering those people’s cholesterol reduces future risk of the event. This is really important and it needs to be clearly communicated to the patients, so they understand the objectives of the doctor.

3. Treatment for an event in ten yearstime.

It is more complicated generally in a prognostic situation, where the patient

takes a medication to prevent an issue that could occur a year or two or ten years down the line. This is where the immediacy of the effect of the agent is nowhere near as clear and where education and explanation are paramount to engage patient in the process. These are people who may come from families where there is high cholesterol and premature coronary disease throughout the family. This is called

Familial Hypercholesterolaemia. There’s no question these people can have the risk of a heart attack reduced in decades to follow by starting their cholesterol therapy early. The trouble is they will only take their medication if they fully understand the benefit it will provide to them because without an explanation of the benefit all they see is the risk (the side effect of the medication).

EDUCATION AND COMMUNICATION WITH THE PATIENT.

That’s why a conversation with the individual and their particular needs is so important and for my patients, particularly the ones who have made decisions about unilaterally stopping drugs. What I do have is a deep desire to make a meaningful difference for individuals based on their particular needs and matching their particular need with the appropriate therapy for them. What I really encourage you to do is engage with your doctor or the person who prescribed that drug to discuss the best way, the unique way to find the solution that best works for you. The very starting point in all this is education. The second point is communication and they go side by side. Finally, I really hope this gives you second thoughts about stopping medication. I hope that it gives you second thoughts about engaging your doctor or your prescriber with your concerns. It’s up to us to articulate that clearly and explain it to you clearly so that you are engaged and part of that process It is a complicated area but what I really encourage you not to take this path alone.