What’s Tripping Up Your Cholesterol Treatment?
Half of all people who’ve been prescribed meds for high cholesterol don’t take them. Here's how to stay on plan.by Matt McMillen Health Writer
If you have high cholesterol, you’ve probably been warned: Failure to control this beast ups your odds of heart disease and can cause a heart attack or stroke. It’s a no brainer to take your meds, right? Wrong.
Remarkably, 50% of all people who’ve been prescribed cholesterol-lowering drugs don’t take them—even though the consequences to heart health can be dire. Blowing off your cholesterol meds can be deadly, says Guy L. Mintz, M.D., director of cardiovascular health and lipidology at Sandra Atlas Bass Heart Hospital in Manhasset, NY. “The stakes are high.”
So, what’s keeping folks from staying the course with a treatment plan? Some people just hate the side effects. Others say routinely remembering to take a pill (or pills) is the problem. As is failing to understanding just how important it is to take your meds.
Let’s take a closer look at the reasons people struggle to stick with their cholesterol-lowering schedule—and why it’s imperative to find a routine that works you.
Why High Cholesterol Is Such a Big Deal
Cholesterol is a waxy fat that circulates in your bloodstream. Your liver produces it to perform some essential tasks, such as forming protective layers around your cells. You get additional cholesterol from certain foods. But eat too much of those foods and your cholesterol levels shoot up, putting your heart health—and your life—at risk.
The main worry is low density lipoprotein (LDL), which you’ve probably heard is called “bad” cholesterol. When it accumulates, it clings to the walls of your blood vessels. The other type of cholesterol, high density lipoprotein (HDL), is the “good” kind because it helps remove bad cholesterol from your body, keeping you healthy. You get into trouble when your LDL level rises and you have too little HDL cholesterol. If the buildup on your blood vessels—called plaque—grows too much, it can block blood flow. That plaque also can rupture, or break apart, which can shut down the flow of blood to your heart or brain. That can kill you.
Why Cholesterol-Lowering Drugs May Be Necessary
Exercise and a healthy diet can help keep cholesterol in check, but most people with high cholesterol will need medications to control it. The most common type of cholesterol-lowering medication falls into a class called statins. These drugs reduce the amount of LDL cholesterol that your liver produces while increasing your HDL level. They also help stabilize plaque buildups that have already formed so that they’re less likely to rupture.
So, Why Aren’t You Taking Your Meds?
There are a lot of reasons why people skip their cholesterol medications. It’s critical to identify and address the reasons. Your heart depends on it.
You just can’t take the side effects. You may not be able to stand the digestive problems, muscle pains, and other unpleasant side effects that statins can sometimes cause. In fact, as many as one in five people with high cholesterol can’t tolerate them. Or, you may worry about rare side effects like liver damage or a boost in your blood sugar, which could heighten your risk of diabetes. Fortunately, you have non-statin options including two PCSK9 inhibitors approved by the FDA, which lower your level of LDL, or “bad,” cholesterol. Other good options include ATP citrate lyase (ACL) inhibitors, fibric acid agents, and selective cholesterol-absorption inhibitors.
Maybe you’re missing support. Some communities may have less access to medical care or health insurance than others, leaving them more vulnerable to missing out on essential medications such as statins. Researchers, writing in the August 2020 issue of the Journal of the American Heart Association, speculate that such circumstances may explain why statin use is so low among Latinx adults with peripheral artery disease. That’s a condition in which narrowed arteries, caused in part by high cholesterol, prevent an adequate amount of blood flow to your limbs, particularly the legs, and it can lead to amputations, according to the Mayo Clinic. The study showed that only one in four took statins, an important part of treatment.
Another study in the same journal, published in December 2020, showed that only one in five adults 40 and older who identified as lesbian, gay, and bisexual (LGB) take statins. Meanwhile, more than double that number of non-LGB adults of the same age said they do take statins. Moreover, 44% of non-LGB adults who had diabetes took statins, compared to just 21% of LGB diabetes patients. The possible reason? LGB adults may go to the doctor less often than other adults. That may leave them less informed about the importance of cholesterol-lowering drugs.
Or, you’re misinformed. Doctors don’t always get it right. That’s particularly true when it comes to women and heart disease, says Dr. Mintz.“Part of the issue is provider naivete in thinking women have less heart disease than men,” says Dr. Mintz. “But heart disease is the leading cause of death in women.”
Your doctor should be emphasizing the lifesaving importance of statins and other cholesterol-lowering drugs. “The blame is on the provider for not educating patients—all patients, regardless of sexual preference or identity—on the importance of therapy,” Dr. Mintz surmises. “The majority of compliance issues can be resolved through the provider spending the time for patient education, and the majority of patients prescribed statin therapy will remain on therapy if they understand why they are taking the medication.”
Cardiologist Michael Goyfman, M.D., director of clinical cardiology at Long Island Jewish Forest Hills in Queens, NY, agrees. “I think the real challenge is a communication problem, and physicians probably do not take the time to listen to their patients to see what the barrier is to taking the medication,” says Dr. Goyfman.
Memory might be the issue. Do you have a good system of reminders in place to keep you from forgetting to take your daily dose? That, says Dr. Goyfman, is one potential barrier to sticking with your treatment plan. Here’s a simple trick that he suggests: Flip your pill bottle upside-down when you take your medication. That way you will know just by looking at it whether you took that day’s pill.
Or, get help from your phone. Numerous apps exist to help you remember to take your medication on schedule. You can set alarms for the prescriptions you take so that you’ll be less likely to forget. Ask your doctor to recommend high- or low-tech options that you can use to maintain your cholesterol medication routine. “The trick is to identify barriers to compliance and work together—doctor and patient—to take down these barriers,” says Dr. Goyfman.
Why Taking Your Meds as Prescribed Is a Top Priority
If you’re prescribed one of these drugs and stop taking it, says Dr. Mintz, your cholesterol will start to climb within 48 hours. In the long term, your risk of heart attack, stroke, and death will rise.
Dr. Mintz says there’s a common misunderstanding that many people, including pharmacists, have about statins. They think they must be taken at night when the body produces cholesterol. Wrong. They stay active in your body for 24 hours, so they can be taken in the morning. That, Dr. Mintz says, will make it easier to stick with your daily dose.
- Statins and Lesbian, Gay, Bisexual Adults: Journal of the American Heart Association. (2020). “Statin Use for Atherosclerotic Cardiovascular Disease Prevention Among Sexual Minority Adults.” ahajournals.org/doi/10.1161/JAHA.120.018233
- Statins and Hispanics/Latinos: Journal of the American Heart Association. (2020). “Underuse of Cardiovascular Medications in Individuals With Known Lower Extremity Peripheral Artery Disease: HCHS/SOL.” ahajournals.org/doi/full/10.1161/JAHA.119.015451
- Statin Adherence: JAMA Cardiology. (2019). “Association of Statin Adherence With Mortality in Patients With Atherosclerotic Cardiovascular Disease.” jamanetwork.com/journals/jamacardiology/article-abstract/2724695
- High Cholesterol: Mayo Clinic. (2019). “High Cholesterol.” mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800