People at risk for heart disease are much more likely to die from a stroke if they don't take cholesterol-lowering statin drugs and blood pressure medications as prescribed, a new study reports.
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Folks with high blood pressure and high cholesterol had a seven times greater risk of suffering a fatal stroke if they didn't follow their drug regimen to lower cholesterol and blood pressure.
The study findings were published online March 28 in the Journal of the American College of Cardiology.
Fatal stroke risk also increased if these patients stuck to one type of medication but not both, the researchers found.
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For example, if patients kept taking blood pressure medication but dropped their statins, their risk of dying from a stroke increased by 82 percent. Turning the tables, they had a 30 percent added risk of stroke if they took their statins but didn't take their blood pressure medications.
"High blood pressure and high cholesterol concentration are key risk factors for stroke for which effective medication is available," said study lead author Kimmo Herttua, head researcher for the Center of Maritime Health and Society at the University of Southern Denmark. "A major obstacle for the full benefits of lipid-lowering and antihypertensive treatments is the non-adherence of patients to drug therapy."
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Stroke is responsible for 12 percent of all deaths worldwide, and it is the second leading cause of death after heart disease, the researchers said.In this study, Herttua and colleagues tracked data on more than 58,000 patients in Finland with high cholesterol levels. During an average 5.5 years of follow-up, 532 died of stroke.
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The researchers used prescription records to track whether people were taking medications as their doctors ordered. They found that only six out of 10 people took statins as prescribed.
Experts cited a number of reasons patients might find it tough to keep up with all their medications.
Doctors struggle to get patients to stick to any sort of health-improving regimen, noted Dr. Nieca Goldberg, a cardiologist and medical director of NYU Langone's Joan H. Tisch Center for Women's Health.
"One of the challenges in taking care of patients is getting them to start a program and get them to continue it, whether it's getting them to exercise, cut down on their sugar intake or take their medicine," she said.
Doctors may not be properly explaining the role of these drugs in their health, and the necessity of taking them as prescribed, Goldberg and Herttua said.
"People need to understand the connection between taking those medicines and preventing a heart attack or stroke," Goldberg said. "Face-to-face time being limited in the doctor's office, that is kind of getting lost in the visit."
Patients also might be struggling to keep up with all of the medications they need to take in a day. "The more medication recommended, the less likely a patient is to remember to take them," Herttua said.
Drug costs also might play a role.
"Generics aren't as cheap anymore. There are rising prices for generics," Goldberg said. "Sometimes instead of not taking the pill at all, a patient may cut the dose. It's important not to do that, because you want to make sure you have the most effective dose."
Finally, people might simply burn out, throwing up their hands in despair at all the steps they must take to maintain their health.
"It's a drag," Goldberg said. "People don't want to feel like a patient. They want to feel like themselves."
New technologies might help people stay on top of their medications, Herttua said. For example, daily text messages could remind patients to take their statins and blood pressure pills.
Medical science also could help by combining different medications into a single "polypill," cutting down on the number of prescriptions a patient has to manage, Herttua said.
Doctors also can help patients by emphasizing the importance of these medications to their brain health, said Dr. Gayatri Devi, a neurologist and memory loss specialist at Lenox Hill Hospital in New York City.
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"The best way to improve compliance in chronic illness is through education about the benefits of doing so," Devi said. "People often ask me how to keep their brains functional as they age. I tell them one of the most effective things they can do is promote cardiovascular health."
How?
"By exercising, following a good Mediterranean diet and adhering to an appropriate medication regimen necessary to control their diabetes, hypertension and high cholesterol, if they have these conditions," Devi said.
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