NBC News recently did a story on why patients ignored their doctor’s advice. The most glaring example of this was Clinton’s failure to take a statin with an LDL of 177. Here are some excerpts:
Andrew Mahoney, Jr., a 43-year-old father of three, learned from his doctor that he had high cholesterol and should take a statin drug. He filled the prescription, but usually neglected to take the pills.
“I wasn’t ready to start a lifetime regimen of taking drugs. I don’t even take aspirin!” says Mahoney.
Almost sounded like he was proud of it. Of course, one of the biggest reasons for patient non-compliance is cost, as was discussed yesterday. However, physicians do not prescribe medications such as statins and aspirin without justification. In most cases, there is evidence behind our decisions – for instance, a decrease in mortality. Take aspirin, a cheap OTC medication. It is recommended by the USPSTF:
The USPSTF found good evidence that aspirin decreases the incidence of coronary heart disease in adults who are at increased risk for heart disease . . . The USPSTF concluded that the balance of benefits and harms is most favorable in patients at high risk of CHD (5-year risk of greater than or equal to 3 percent) but is also influenced by patient preferences.
Your risk of CHD (coronary heart disease) can be can be calculated by the Framingham Risk Score (note that 5-year risk of 3 percent is equivalent to a 10-year risk of 6 percent).
Bill Clinton was also prescribed a statin and stopped taking it. Many doctors think that may have played a role in his getting heart disease.
About 15 million Americans have prescriptions for statins. Government guidelines say the number should be three-times that many. But studies show that about one-quarter of the time, even those with prescriptions don’t take the pills.
If cost is an issue, then discuss this with your physician, since there are other, cheaper cholesterol medications available (i.e. Niacin). However, if patients simply don’t want to take it, physicians can only do so much.
