Heart disease remains one of the leading causes of death worldwide. To lower this risk, doctors frequently prescribe statin drugs, which work by reducing low-density lipoprotein (LDL) cholesterol – often referred to as “bad” cholesterol – that can accumulate in the arteries and lead to heart attacks or strokes. More than 200 million people globally rely on statins to protect their cardiovascular health.
Despite their well-established benefits, a significant number of individuals remain hesitant to use them. A recent study published in JAMA Internal Medicine suggests that patients often require a perceived risk reduction two to three times greater than what statins typically provide in clinical practice before they consider daily medication.
Researchers from Japan surveyed a total of 551 adults – 254 in the United States and 297 in Japan – all between the ages of 40 and 75, who had never taken statins. Participants were presented with a straightforward question: what level of risk reduction in cardiovascular disease would be necessary for them to find the medication worthwhile?
The findings revealed a concerning trend. Even among individuals with a moderate 10% risk of developing a heart condition within the next decade, 42.9% of US adults and 42.4% of Japanese adults expressed reluctance to take statins after being informed of the drug’s effectiveness and potential side effects. Researchers believe this disconnect between patient expectations and the actual benefits offered by statins may contribute to suboptimal adherence to prescribed treatment plans.
How Statins Work
Statin drugs function by targeting and blocking the enzyme HMG-CoA reductase, a crucial component in the body’s natural cholesterol production process. By inhibiting this enzyme, statins effectively lower levels of LDL cholesterol and contribute to the removal of cholesterol from arterial plaque – the waxy buildup within artery walls that narrows blood vessels, restricts blood flow, and elevates the risk of heart attacks and strokes.
Current guidelines from the American College of Cardiology and the American Heart Association recommend statin therapy for individuals with a 10-year risk of heart disease or stroke of 7.5% or higher. Some experts even suggest considering treatment for those with lower risks, around 3–5%. However, these guidelines are largely based on expert recommendations, with limited direct input from patients regarding their preferences.
Prior research has consistently demonstrated that even when individuals are fully informed about the benefits and potential side effects of statins, many still exhibit hesitation, creating a gap between medically indicated treatment and patient willingness.
Understanding Patient Preferences
In this study, the research team aimed to quantify this gap more precisely using a metric known as the smallest worthwhile difference (SWD). This patient-centered metric captures the minimum absolute risk reduction an individual deems necessary to justify initiating treatment.
Participants from both the United States and Japan were informed that, currently, most statins can reduce the risk of cardiovascular disease by approximately 25% across various risk levels.
The survey data revealed that at a very low baseline risk of 2%, a substantial 75.6% of US participants and 62.3% of Japanese participants stated they would not take statins, even if the drug could reduce their risk to zero. This refusal rate decreased as risk increased to 10%, with approximately 42% declining statins in both groups. At a 20% risk level, the refusal rate was 23.6% and 38.4%, respectively.
Individuals in both low- and high-risk groups indicated they would require statins to reduce their 10-year risk by at least 7.5 percentage points before considering treatment – representing a 50–75% reduction, significantly exceeding the actual benefits provided by the drugs. However, as baseline risk increased, participants demonstrated a willingness to accept a smaller benefit in exchange for taking the medication.
The researchers suggest that incorporating SWD into clinical guidelines could help bridge the gap between medical recommendations and patient preferences, fostering a more collaborative and informed decision-making process between healthcare providers and their patients.
On , a separate study published by ScienceDaily found that a massive review of 23 randomized trials showed that statins do not cause the vast majority of side effects listed on their labels. Memory problems, depression, sleep issues, weight gain, and many other symptoms appeared just as often in people taking a placebo. Only a few side effects showed any link to statins — and even those were rare.
