Heart disease remains one of the leading causes of death worldwide. To lower this risk, doctors prescribe statin drugs that reduce low-density lipoprotein (LDL) cholesterol, the type that can accumulate in the arteries and lead to heart attacks or strokes. More than 200 million people take statin drugs to protect their heart health.
Despite their well-established benefits, researchers have found that many people remain reluctant to use them. A recent study in JAMA Internal Medicine suggests that patients often expect two to three times more risk reduction than statins actually provide in clinical practice before they consider taking the medication daily.
A team of Japanese researchers surveyed 254 adults in the United States and 297 adults in Japan, all aged 40 to 75, who had never taken statins. They asked one simple question: how much would statins need to lower the risk of cardiovascular disease for them to feel the medication is worth taking?
Even at a moderate risk (10%) of developing a heart condition within the next 10 years, 42.9% of US adults and 42.4% of Japanese adults declined to take statins after knowing how effective the drug is and what side effects it can have. The researchers find these numbers concerning, as they believe gaps between what people expect and what clinical guidelines recommend may contribute to low statin adherence.
Removing the bad player
Statin drugs target and block the liver enzyme HMG-CoA reductase, which plays a pivotal role in the body’s natural cholesterol production. By inhibiting this enzyme, statins lower levels of bad LDL cholesterol and remove cholesterol from arterial plaque—a waxy buildup that forms inside the walls of arteries that can narrow blood vessels, restrict blood flow, and increase the risk of heart attacks.
Current guidelines from the American College of Cardiology and the American Heart Association recommend statins for people with a 10-year risk of heart disease or stroke of 7.5% or higher. Some experts even suggest considering treatment at even lower risks, around 3–5%. However, these guidelines on who should take statins are mostly based on expert recommendations, with little input from patients themselves.
Previous studies have found that even when people know the benefits and side effects of statins, many still hesitate to take them, thus creating a gap between what is needed for medical reasons and preferred by patients.
Understanding patient preference
In this study, the team set out to measure the gap more precisely using a metric called the smallest worthwhile difference (SWD)—a patient preference-focused metric that captures the minimum absolute risk reduction a person considers necessary to justify starting a treatment.
Participants from both countries, the US and Japan, were informed that, at present, most statins can lower the risk of cardiovascular disease by about 25% across different risk levels.
The survey revealed that at a very low baseline risk of 2%, 75.6% of US and 62.3% of Japanese participants said they would not take statins, even if the drug could reduce their risk to zero. This refusal dropped as risk increased to 10%, where ~42% declined statins in both the groups, and at 20% risk, it was 23.6% and 38.4% still refusing to take statin.
People in both low- and high-risk groups expected statins to cut their 10-year risk by at least 7.5 percentage points before they would consider taking them—that’s a 50–75% reduction, far above what the drugs actually deliver. However, as baseline risk increased, people were willing to accept a smaller benefit to take the medication.
The researchers suggest that SWD could help bring patient preferences into clinical guidelines and provide a clearer framework for shared decision-making between doctors and patients.