MedLine Plus, a publication of the National Institute of Health’s (NIH) library, published an article on Nov. 8, 2015 titled “ ‘Cash for Lower Cholesterol’ Program Works with Doc-Patient Teams. Cooperation is key to program’s success, but benefits were modest, study finds.” The lead researcher of the study was David Asch, MD from the University of Pennsylvania.
The study results showed that paying the doctor and the patient achieved a modest 8.5 mg/dL reduction in LDL, which was interpreted as avoiding about 4% of heart attacks or strokes within that group. The study was run over the course of one year on about 1,500 patients using 340 primary care physicians. Patients that were grouped by being paid, but not the doctor showed no significant improvement. The group that had the doctor paid, but not the patient also showed no significant improvement. The monetary amount was $1,024 each for patients and doctors under the different rules of the study. A control group received no money for adhering to their statin regimen, but probably received free statins during the trial.
While Asch felt that the plan that had doctors and patients paid had some results, it is questionable whether the money made much difference. The statins were dispensed using an electronic pill bottle that logged whether patients took their statins as directed.
It makes sense. It does take two to tango. The physician has to prescribe the medication, and the patient has to take it. They both have to follow through on their roles for this to work.
Pam Morris, MD of the University of South Carolina, summarized the results from her vantage as Chair of the Prevention of Cardiovascular Disease for the American College of Cardiology. The shared-incentive group adhered to their schedule 39%, while those in the patient incentive group adhered to the schedule 34%. The control group had an adherence rate of 24%.
It was a very modest effect. It raises questions about the cost-effectiveness of this model. I found really shocking the incredibly poor adherence across all groups, even for those with financial incentives. They were being offered money. What does it take to get the type of adherence to therapy that will improve health? What more do we need to do?
The Mayo Clinic provides guidance in considering the benefits and risks of taking statins. Adverse effects increase with the age of the patient, and the dosage of the statin. Muscle pain is a more frequent side effect than elevated liver enzymes. Rare side effects lead to organ failures and death. Statins can raise blood sugar to create type 2 diabetes. Statins have been related to memory loss and mental acuity. Claims that statins prevent cancer have little proof, as do claims that statins prevent first heart attacks. It would be fruitful for the researchers to ask the 1,500 patients why they aren’t taking the statins, with or without extra compensation.
If you are offered or prescribed statins, you should consider the overall risk/benefit analysis. If you begin taking statins, you should pay attention to your body’s reaction to the drug in terms of muscle pain, increased blood sugar, liver pain, and confusion or memory loss. Statins are one of the most aggressively marketed of all drugs. Talk with your doctor about whether you really need statins.
Diet, exercise, and natural remedies such as plant sterols, antioxidants and Omega-3 fish oils can help lower LDL cholesterol without the common side effects of statins. A conscientious program to improve your cardiac health will include eating foods without trans fats, reduced red meat, more vegetables, and foods high in antioxidants and Omega-3 oils. You will also need regular exercise to reduce your weight, strengthen your heart, and lower your risk of type 2 diabetes that increases risk of cardiac diseases significantly.