Nearly Half of Patients Nonadherent to High Cholesterol Treatment

Retail clinicians have their work cut out for them on improving medication adherence among patients with high cholesterol.

Around 44.5% of patients who should be taking cholesterol-lowering medications are not doing so, according to a US Centers for Disease Control and Prevention (CDC) report.

Nurse practitioners and physician assistants working in retail clinics are surely seeing some of the 78.1 million Americans who are taking these medications or eligible for starting them, based on American College of Cardiology and American Heart Association guidelines.

These guidelines suggest the populations that would benefit from cholesterol-lowering medications are:

• Patients with heart disease or a history of heart attack or some types of stroke or angina
• Patients who have low-density lipoprotein (LDL) cholesterol levels of 190 mg/dL or higher
• Patients aged 40 to 75 years with diabetes and LDL levels between 70 to 189 mg/dL
• Those described above who also have an estimated 10-year risk of heart disease of 7.5% or more

The CDC examined national health and nutrition data from 2005 to 2012 and found that around 36% of Americans were taking or eligible for cholesterol-lowering treatment.

The researchers’ key findings were:

• 55.5% were taking their cholesterol medications
• 46.6% were making lifestyle changes such as exercising, losing weight, or eating fewer high-fat or high-cholesterol foods
• 37.1% were taking their cholesterol medications and making lifestyle changes
• 35.5% were not taking their cholesterol medications or making lifestyle changes

Overall, patients who had adopted a heart-healthy lifestyle were most likely (80%) to take their medications.

The researchers also discovered that women were more likely to be taking their cholesterol-lowering medications than men, and white patients were more likely to take their medications than Mexican-Americans and African-Americans.

Retail clinicians could be of most help to African-American patients who do not have a routine place to access health care, as this patient population was the least likely (5.7%) to take cholesterol-lowering medication. Retail clinics’ accessibility could encourage more African-American patients to seek regular care to monitor their cholesterol levels.

“Further efforts by clinicians and public health practitioners are needed to implement complementary and targeted patient education and disease management programs to reduce sex and racial/ethnic disparities among adults eligible for treatment of cholesterol,” the researchers concluded.

For nearly 90% of the patients on a cholesterol-lowering drug, the medication was a statin.

One of the study’s limitations was that the number of eligible adults might be underestimated, since the survey data did not take into consideration older adults in nursing homes or other institutions. In addition, self-reported data can be affected by recall bias.

The goal of the US Department of Health and Human Services’ Million Hearts initiative is to have 65% of Americans get control of their LDL cholesterol levels by 2017 in order to prevent 1 million heart attacks and stroke.

Adults aren’t the only ones with big cholesterol goals to tackle. A recent CDC data brief found that 1 in 5 children have high total cholesterol, low high-density lipoprotein (HDL) cholesterol, or high non-HDL cholesterol.