Health care providers can manage “fake news” about statins, including their indications and misinformation regarding liver and kidney damage.
In an interview with Pharmacy Times, Eugenia Gianos, MD, Director of Cardiovascular Prevention at Northwell Health, discussed her presentation at the American College of Cardiology 2023 Scientific Session. Gianos’s presentation discussed how health care providers can manage “fake news” about statins, including their indications and misinformation regarding liver and kidney damage.
Q: What kinds of misinformation do you typically see regarding statins?
Eugenia Gianos, MD: Some of the most common misconceptions from patients on statins are related to liver and kidney disease. Very frequently, they've heard that these medications damage their liver and damage their kidneys, which in fact is not only not true, but potentially they may have benefits in protecting patients against kidney and liver disease and have improvements in some cases in those circumstances. So, it's really important for us to have this data at hand when coming up with answers for patients and explaining the situation to them.
One of the most common misconceptions with respect to patients is related to myalgia. In fact, they happen; patients do have muscle symptoms related to statins. However, they are very difficult to tease out in terms of causality and can be very confusing. It's important for patients to understand that in clinical trials, about 5% or so of patients do experience this [and] it's a little higher in observational data—about 10% to 15%. However, for the majority of people, [statins] are very well tolerated without issues. Also, what's important is that it's been seen in many of the run-in phases for clinical trials that patients have a hard time distinguishing this. Many of them have myalgias on placebo and not on statin at all. So, it is somewhat of a subjective issue [and] patients need to be diligent about understanding where their symptoms are coming from, whether in fact it's caused by the statin.
Q: Has this misinformation always been circulating, or is it part of the newer wave of medical misinformation in recent years?
Eugenia Gianos, MD: So, there's no question that the way that information gets put out in the media nowadays and on the internet without a need for sound scientific backing contributes to the fact that statin misinformation persists. This is a huge problem. And the issue goes way back, I think probably because some of the symptoms of statins are subjective and because they do actually increase liver enzymes a little bit, [but] not in a negative way and not leading to disease. Because those things are out there. There is already a perception in patients’ minds that there is a negative association with this type of medication. Interestingly, when you look at the searches on the internet, they're years a few years ago, there was about 600,000 searches for statin benefits and over 3 million for statin risks. So, patients are concerned. There is some information out there that is leading them to be concerned about statins and the misinformation that keeps getting put out there without backing of scientific evidence is really not helping the situation.
Q: Why is this misinformation so prevalent and what impacts does it have on patients?
Eugenia Gianos, MD: The most important issue with misinformation with respect to statins is that it really is impeding patient care. Essentially, statins have such great benefit where if you lower cholesterol by about 40 mg/dL, you can reduce cardiovascular events by about 20%. That is a huge benefit. And anything that stands in the way of a patient initiating or adhering to medication really is impairing their long-term outcomes. It is essentially not allowing us to prevent heart attacks and strokes with a very common medication that is safe, that is well studied, that has great evidence out there for cardiovascular benefits.
Q: How can pharmacists help walk patients through the risks and benefits with statins?
Eugenia Gianos, MD: I think every clinician and person that comes in contact with a patient has a role here, and perhaps the pharmacist even more so. There is a certain trust that patients have for their pharmacists; there's a bit of a more relaxed relationship, maybe better, easy access to a pharmacist that a patient has where pharmacists can have a tremendous impact on that patient. Some of the more important things that pharmacists can do is have some of this important information available and some of the key facts from data, from trials, from observational studies, available to explain to the patient so that every time a patient has a concern, well, “Won't this affect my kidneys? Won't this damage my liver? Won't I develop dementia from this medication?” That they can easily present the important facts of what we know from trials and show the evidence to the patient in an easy, digestible way, so that the patient can feel more reassured that they are safe to take this medication and to understand the benefit of the medication.
One important fact to have available for your patients is related to supplements. Patients are very frequently taking multiple dietary supplements under the impression that they are going to significantly lower their cholesterol and they deem them to be more safe than taking statins. Recently, there was a trial released, the SPORT trial, that compared low dose of rosuvastatin 10 mg to a number of different dietary supplements that patients take regularly to lower their cholesterol, and to placebo. And after a month, it was evident that there was no significant benefit to taking those variety of supplements. And really, it was just the rosuvastatin that had a significant impact on lowering cholesterol. So, I think that's a very simple trial that, if presented well to a patient who has been taking supplements and perhaps spending lots of money under the impression that they are getting cholesterol lowering, just having that evidence in a simple conversation for a patient can really make a difference in convincing them to be on a statin.
One important thing in terms of the conversation around statins is explaining the benefit. Sometimes patients feel that this is only lowering their cholesterol, but they don't understand the impact on their cardiovascular outcomes. Sometimes they feel that their cholesterol is not that high, so why do they need to even take the cholesterol medication? In fact, if a patient is at high risk for cardiovascular events, even if their cholesterol is not that high, they still stand to benefit tremendously from the medication. And that's something that's a little harder, I think, to understand for patients. So that's also an important message that pharmacists can communicate to the patient, about why they would be getting so much benefit from this medication.
Q: Why are pharmacists well positioned to tackle this misinformation?
Eugenia Gianos, MD: So, pharmacists have a tremendous benefit with respect to working with patients. And it's been shown in studies previously that programs where pharmacists were part of the integral program for a patient with respect to medication adherence, really do have efficacy for improving medication adherence. It's probably related somewhat to the fact that they are integrated more closely into the patient care, perhaps with more easy access. But pharmacists really do have a direct connection with patients, potentially a benefit of having a strong relationship with them, where they can have a very, very big impact on their outcomes. What we're finding is that multidisciplinary approaches where different clinicians work together are really the most successful. Having interactions between clinicians, pharmacists, other advanced care professionals who are all working together on the behalf of the patient, is really the most successful way that we can get patients to improve outcomes. I think we have a lot of therapies out there and so many more that are coming to the market, and one important thing is really focusing more on the implementation science and how we can be sure that these medications are getting to our patients.
Q: How can pharmacists approach these conversations, particularly with patients who may be adamantly against statin use?
Eugenia Gianos, MD: So, all of us, in working with patients, whether we are physicians, advanced care practitioners, pharmacists, come across patients with very, very strong beliefs against using statins. And it's important for all of us to approach that patient understanding that they have come to that point based on a lot of what they've learned, perhaps what they have around them in their environment, the experiences of others perhaps, and it really aligns very much with what their values are. So, I think understanding where the patient is coming from, who has that very strong opinion against the statins is key. So, the first most important thing in that interaction is to respect the patient's views, to explain to the patient that ultimately the decision is up to them really as to whether they're going to continue. That, really, they have the power to decide on this issue. And I think when you come from the standpoint of respecting their views, working with them to understand the misconceptions, and really showing them the benefits, you're more likely to succeed in altering their views.
Q: What key take-home message would you like to leave with pharmacists?
Eugenia Gianos, MD: One important message that I want pharmacists and all clinicians perhaps to understand is that we all have tremendous power to improve outcomes through improving medication adherence. It's amazing how we can potentially reduce the amount of disease we see in terms have heart attacks and strokes, possibly even more so than some of the most advanced therapies that are out there, if we simply are successful in helping the patients to take these medications regularly. You wouldn't think that's the case, but the power to improve health in this relationship in this programmatic approach is really tremendous.