Alerting patients to their risk of cardiovascular disease and offering them a potentially healthier future would seem to be just the incentive patients need to clean up their lifestyle. Instead, a paper published Wednesday in the online Journal of the American Heart Association finds that starting patients on preventive therapy seems to lead to lower activity levels and weight gain.
The Finnish Public Sector study was used to conduct baseline and 4-year follow-up surveys among 8,837 initiators of antihypertensive medications or statins and 46,021 study participants who were not started on therapy. Patients who took cholesterol- or blood pressure-lowering medications were more likely to reduce their activity levels and 8% more likely to become physically inactive. Also, they were 82% more likely to become obese or have an increase in body mass index (BMI) compared to the non-initiators, the study reported.
Thus, rather than incentivize patients to a healthier lifestyle, these preventive therapies may end up being a substitute for it. As Maarit Korhonen, PhD, lead author of the study and senior researcher at the University of Turku in Finland, put it in a statement: “Medication shouldn’t be viewed as a free pass to continue or start an unhealthy lifestyle.”
One important consideration: the authors acknowledge that their results may mean that the expansion of preventive therapies to low-cardiovascular-risk patients may not produce the population-level benefits expected.
There was some good news: individuals starting therapy were 26% more likely to quit smoking and more likely to reduce their alcohol consumption. While it is true that people often gain weight when they stop smoking, this did not explain the body mass index increase found in the study. Participants who took their medications and stopped smoking gained more weight than those who did not initiate medications but still stopped smoking.
If risk-factor awareness alone is not enough to improve behavior, what does it take for prevention that works?
Recent primary prevention guidelines in the U.S. and Europe emphasize cognitive-behavioral strategies (e.g., motivational interviewing, shared decision making), and evaluation of social and other individual-level determinants of health when choosing the optimal strategy for each patient.
Plus, like other areas of cardiology, prevention is finding value in a team-based care approach. The American College of Cardiology/American Heart Association primary prevention guidelines suggest that the most effective clinical strategy may be one that uses input from a dietician/nutritionist and a pharmacist to make sure individuals get the best advice regarding a healthy lifestyle or how to quit smoking. Like other successful cardiovascular interventions that use team-based care, in the setting of primary prevention these might include telehealth monitoring, follow-up support aids and patient education.
The extra effort may just make the difference between therapies that are a substitute for a lifestyle tune-up – and preventive medicine that is allowed to work.
Korhonen MJ; Pentti J, Hartikainen J, et al. Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid-Lowering Medication: A Cohort Study. J Am Heart Assoc 2020;9:e014168. DOI: 10.1161/JAHA.119.014168. https://www.ahajournals.org/doi/10.1161/JAHA.119.014168
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;74:1376-414. http://www.onlinejacc.org/content/74/10/1376