Hyderabad: Patients who do not use statins despite having high cholesterol levels due to the side effects are at an increased risk of death, stated a study by the European Heart Journal. The study released earlier this month covering 6,74,900 people aged 40 years and above showed that early statin discontinuation had increased from 6 per cent in 1995 to 18 per cent in 2010.
This was related to negative statin related discussions, statin doses and also men living alone in cities. Early discontinuation of statin was associated with increased risk of myocardial infraction and death from cardiovascular diseases, concluded the study.
In India, discontinuation is very rampant because patients are intimidated by the side-effects. Dr Shashi Kant, senior cardiologist at Yashoda Hospitals, said, “We find that patients are not advised properly in terms of the benefits of the statin and its side effects. When they are told that these side effects will take place, but the pain, inflammation is minor compared to the benefit of the medicine, then patient compliance is high.”
In India the drop out rate from prescriptions by general practitioners is 3:10 and by cardiologists it is 1:20. This is because the “actual effect” of statin is seen only after a decade’s use and not immediately. Dr Kant added, “Similarly, stopping it immediately does not risk immediate setting in of cardiovascular disease or heart attack. It is the long duration of continued discontinuation which causes the disease and death.”
Dr C. Venkata S. Ram, director at Apollo Institute for Blood Pressure Management said, “There is a lot of argument coming up in preventive use of statins in primary care. This is because when the bad cholesterol levels are high and need to be brought down by statin, there is a hesitation because of side-effects. But in many cases, we are finding that despite counseling for changing lifestyle and diet there has not been much of an impact and medication is required for the same. In such cases, the option of preventive care must be exercised.”
At the same time, cardiologists state that people are being misled by the pain caused by the medicine. Cardiologist Dr Sunil Kapoor said, “The drug has been in use since the last 20 years and it has shown good results in controlling bad cholesterol.It has been found that the damaged cells are the storehouses of bad cholesterol deposits and if medication is not given then the deposition continues. The question at clinical level is to save the patient from an impending heart attack or paralytic stroke or manage the side-effects which are comparatively very minimal.”
With many general practitioners now hesitating to prescribe statins, cardiologists say that they are seeing increased cases of bad cholesterol which is not a good trend.
General physician Dr G. Srinivas said, “A caution is being exercised because some patients develop liver problems. Earlier, live function test was done once a year to check how the statins are working. But now that practice is not being followed religiously. Some patients are not willing to choose other options like exercise and diet control and continue to take statins without coming for follow-ups. This abuse leads to complications which has made us very cautious.”
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