Cholesterol Control and Car Accidents
If the title of this editorial strikes you as odd, let me explain. As health care providers, we work a lot with our patients with diabetes to try to make sure that their risk of heart disease is as low as possible. The development of a number of key medications in the past 30 years has helped us do that. Clinical guidelines on how to use those medicines are now widely distributed, and both electronic prescribing and advances in electronic health records allow us to remind prescribers when key medicines may be missing or are not prescribed for individual patients. The difficulty now is helping patients stay on the increasingly large number of medications that are needed to help maintain good health.
At a recent American Heart Association meeting, two trials were presented that highlight our dilemma. The first one showed that when a new anticoagulation medicine (similar to warfarin or Coumadin) is added to five other medicines taken after a heart attack, it can provide additional benefit for reducing the risk of a repeat heart attack. The second trial showed that only about 10 percent of patients with commercial health insurance were still on three of the most important medications that we know help to prevent repeat heart attacks (an ACE inhibitor, a statin, and a beta blocker). Ten percent is really low. So what is the disconnect?
Studies suggest many reasons why people cannot or do not take their medicines appropriately. They range from things as simple as misunderstandings about how and when to take medications to more complicated reasons, such as disagreeing with a prescriber over the value of the medications themselves. And sometimes, there are just so many medications that it gets hard to keep track of them all.
The title of this editorial refers to a study published in 2009, which showed that people who took cholesterol medication as prescribed were less likely to get into motor vehicle accidents compared with people who did not take those same cholesterol medicines appropriately. So do cholesterol medicines reduce car accidents? No. What the study showed us was that people who take their medications as prescribed tend to lead healthier and safer lives in a number of important ways. In that same study, patients who followed medication instructions were also more likely to receive their appropriate vaccinations as well as other important preventive services such as mammograms and bone-density screening.
So, will taking cholesterol medicines (or getting a friend or family member with diabetes to take medicines) reduce the number of car accidents? No. But it will reduce the chance of having a heart attack or stroke, which is a pretty good place to start. Even more important is realizing that medications are just one part of living a healthier life. And that’s what really matters.