One in three people surveyed strongly oppose taking medication to ward off heart attack and stroke.
Some people are willing to trade a year or two of life to avoid taking more pills.
One puzzle for physicians and researchers is why large numbers of people are reluctant to take medication that may prevent or control heart disease. The top killer of adults in the United States, heart disease claimed nearly 600,000 lives in 2012, according to the Centers for Disease Control and Prevention (CDC).
While most people might be willing to take a daily pill to help ward off heart disease, 30 percent of people surveyed see it as reducing their quality of life, and are not willing to take medication, researchers found. This is backed up by data showing many stop taking their heart disease prevention drugs over the course of a year.
Trading Years of Life for Quality of Life
Researchers surveyed 1,000 people over the age of 30, and asked them questions online to determine their preferences on taking a hypothetical daily pill to prevent cardiovascular disease.
- 70 percent were not willing to make any tradeoff of years of life.
- Some were willing to trade a few weeks of their lifespan to avoid pills.
- Over 10 percent were willing to trade a year or two of life to avoid the pills.
- Patients were willing to pay an average of $1,445 to avoid a daily pill.
“There is some quality-of-life effect of having to take pills everyday for cardiovascular prevention,” says study author Robert Hutchins, MD, MPH, an internal medicine resident at the University of California, San Francisco. “All people have preferences on what they value in life. It reiterates to the physician that a decision to put someone on a medication, as harmless as it seems… needs to be a mutual decision between the patient and the provider.”
While she says it’s reassuring that most patients would take a daily pill, Donna Arnett, PhD, MSPH, notes that the study also highlights many of the unknowns that exist in research on how to prevent heart disease. Dr. Arnett is former president of the American Heart Association and chair of the department of epidemiology at the University of Alabama at Birmingham School of Public Health.
Medications Treat Silent Symptoms of Heart Disease
Pills given to prevent heart disease are often to control high blood pressure or high cholesterol. But because these don’t have obvious symptoms, patients are told to add a daily routine for which they won’t see a clear, immediate benefit.
“Patients have to have a really good understanding of the importance of taking the medications,” says Arnett.
At the same time, she says, there isn’t a strong understanding of why patients may be hesitant to take a daily pill. There could be any number of reasons policymakers need to address, such as drug costs, the difficulty of getting to a physician to get a prescription refilled, or even being able to get to a pharmacy to pick up the medication.
“There’s not enough research in that area,” says Arnett. Another challenge, she adds, is seeing how the hypotheticals translate when people are told by their doctor to take a pill to help limit their heart risk.
She asks, “About 30 percent of patients aren’t willing to take a daily pill to prevent cardiovascular disease — are these the same patients who would comparably not refill their prescriptions later after being prescribed them?”
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Some Strongly Oppose a Daily Pill
Arnett and Hutchins both said future research in preventing heart disease could benefit from following patients to understand the reasons why some don’t fill their prescriptions.
As many as 40 percent of patients will stop filling their prescriptions after a year, says Hayden Bosworth, PhD, a professor of medicine at the Duke University School of Medicine. Part of the challenge now is finding ways for physicians to communicate with their patients about risks and also about alternatives for patients who strongly oppose a daily pill.
“I think there’s a carrot and a stick. That’s fine if you don’t want to take the medication, but if you’re at risk… you need to really buckle down and focus on lifestyle,” Dr. Bosworth says.
For some that may mean losing five or 10 pounds through diet and exercise, but for others that number may be closer to 30 or 40 pounds.
“No medication is foolproof, nor is any medication totally side-effect free. But these are pretty safe medications that have shown efficacy, are cheap, and are worth considering if you’re at risk,” says Bosworth.
Articles & picture from ：everydayhealth.com