Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Micrograph showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain. Credit: Nephron/Wikipedia

Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially life-saving drugs, according to research published today.

Individuals who have had a are at risk of a second stroke, which carries a greater risk of disability and death than first time strokes. In fact, one third of all strokes occur in individuals who have previously had a stroke. To prevent this recurrence, patients are offered secondary preventative medications; however, adherence is a problem with 30% of failing to take their medications as prescribed.

To examine the barriers to taking these medications, researchers at the University of Cambridge and Queen Mary University, London (QMUL), analysed posts to TalkStroke, a UK-based online forum hosted by the Stroke Association, across a seven year period (2004-2011). The forum was used by stroke survivors and their carers.

The team, led by Dr Anna De Simoni, a lecturer in Primary Care Research at QMUL and visiting researcher at the Department of Public Health and Primary Care, University of Cambridge, has previously used the forum to explore issues such as the impairment that can make it difficult for stroke survivors to maintain a job.

The findings of the study, which looked at posts by 84 participants, including 49 stroke survivors and 33 caregivers, are published today in the journal BMJ Open. The Stroke Association gave the researchers permission to analyse the results, and to prevent identification of individuals, the team did not use verbatim comments.

Among the reasons cited by the forum users, side effects were a major factor in decisions to stop taking medication. Several contributors had experienced negative side effects and as a result had stopped taking the medication, sometimes in consultation with their GP and other times unilaterally. Others reported that they, or the person they were caring for, had stopped taking the medication after reading negative stories in the press about side effects.

Other users expressed concerns over the medication they were offered. There were conflicting views about the efficacy of the medications - some contributors believed they were very important, while others believed that their risk could be managed by lifestyle changes alone.

Contributors also reported mixed views of healthcare professionals—some felt confident in their doctor's decision, while others questioned their decisions, some even questioning their motivation for prescribing particular drugs.

"These findings have highlighted the need for an open, honest dialogue between patients and/or their carers, and healthcare professionals," says Dr De Simoni. "Doctors need to listen to these concerns, discuss the benefits and drawbacks of taking the medication, and be willing to support a patient's informed decision to refuse medications."

However, perceptions did not present the only barriers to adherence: there were often practical considerations. Drugs were sometimes too large and difficult to swallow, or a drug regime was too burdensome. The complexities of the drug regimes sometimes meant having to develop routines and strategies to ensure patients kept to them. One survivor described having to pay for the medications by credit card as she was unable to work and had no money or benefits coming in.

"By analysing people's views as expressed in online forums, where they are more open and less guarded, we've seen some valuable insights into why some stroke survivors have difficulty adhering to their medication," says PhD candidate and first author James Jamison from the Department of Public Health and Primary Care at Cambridge.

"Challenging negative beliefs about medication and adopting practices that make routines for taking simpler, particularly for those patients who have suffered disability as a result of stroke, should increase adherence and ultimately improve health outcomes."

Explore further: Some stroke survivors disregard doctors' advice on medications

More information: Jamison, J et al. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: Analysis of survivors' and caregivers' views from an online stroke forum. BMJ Open; 19 July 2017; DOI: 10.17863/CAM.10458

Related Stories

Some stroke survivors disregard doctors' advice on medications

April 10, 2017
Some stroke survivors say they are disregarding general practitioners' (GP) advice on secondary prevention medications, such as statins, with some patients stopping their medication completely, according to a study of an ...

Stroke survivors face 'invisible impairments' to return to work

April 6, 2016
'Invisible impairments' can make it difficult for stroke survivors to maintain a job, according to a study from the University of Cambridge and Queen Mary University of London (QMUL). The findings, published today in the ...

Stroke survivors with PTSD more likely to avoid treatment

January 18, 2013
A new survey of stroke survivors has shown that those with post-traumatic stress disorder (PTSD) are less likely to adhere to treatment regimens that reduce the risk of an additional stroke. Researchers found that 65 percent ...

Most atrial fibrillation patients don't get preventive drug before stroke

March 14, 2017
More than 80 percent of stroke patients with a history of atrial fibrillation either received not enough or no anticoagulation therapy prior to having a stroke, despite the drugs' proven record of reducing stroke risk, according ...

Stroke survivors using mail order pharmacies more likely to take meds

February 19, 2016
Stroke survivors who get medications by mail are more likely to take them as directed than patients who get medications from local pharmacies, according to research presented at the American Stroke Association's International ...

Recommended for you

Laser device placed on the heart identifies insufficient oxygenation better than other measures

September 20, 2017
A new device can assess in real time whether the body's tissues are receiving enough oxygen and, placed on the heart, can predict cardiac arrest in critically ill heart patients, report researchers at Boston Children's Hospital ...

Metabolism switch signals end for healing hearts

September 19, 2017
Researchers have identified the process that shuts down the human heart's ability to heal itself, and are now searching for a drug to reverse it.

Beta blockers not needed after heart attack if other medications taken

September 18, 2017
A new study from the University of North Carolina at Chapel Hill finds beta blockers are not needed after a heart attack if heart-attack survivors are taking ACE inhibitors and statins. The study is the first to challenge ...

Which single behavior best prevents high blood pressure?

September 15, 2017
(HealthDay)—You probably already know that certain healthy lifestyle behaviors can reduce your risk of developing high blood pressure, but is any one behavior more important than the others?

RESPECT trial shows closing a small hole in heart may protect against recurrent stroke

September 13, 2017
A device used to close a small hole in the heart may benefit certain stroke patients by providing an extra layer of protection for those facing years of ongoing stroke risk, according to the results of a large clinical trial ...

Study shows so-called 'healthy obesity' is harmful to cardiovascular health

September 11, 2017
Clinicians are being warned not to ignore the increased cardiovascular health risks of those who are classed as either 'healthy obese' or deemed to be 'normal weight' but have metabolic abnormalities such as diabetes.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

robrah
not rated yet Aug 01, 2017
The medical establishment seems determined to convince everyone that reactions to statins are imaginary. I know that is not true. On three separate occasions I have begun statin treatment after having stopped for many months. Each time, I experienced a reaction (a strange sense of a combination of both weakness & pain in my upper arms and legs). Finally, a doctor decided to try an experiment: a very low dose of statin every other day for a few weeks, gradually increasing dose and frequency to the preferred amount. Guess what? It worked. No reaction. But should this be surprising? Isn't gradually increasing exposure often the solution to physiological problems? Why isn't this practice more widespread?

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.