January 11, 2012

Surprise, Statins Not Shoved at Us!


This is a pleasant surprise, at the least the part of not having statins shoved at us. I am surprised that this study was allowed to go forward or even be published since statins are not mentioned. It is going to be very interesting to see how long this study stays posted before people are asking that it be pulled because statins are not mentioned or recommended.

Now, to the study, which says patients have time to learn lifestyle changes before drugs may become necessary. This is for people diagnosed with diabetes and hypertension. It could have included prediabetes and should include this. The savings for cost analysis would have been greater and possibly easier for the patients to adjust their lifestyles.

While the study mentions diabetes, it on the control of high blood pressure as the key for the time allowed before medications are needed. Yes, some people are able to manage diabetes without medications and this should be the goal for all patients. Some may need medication assistance until lifestyle changes are made to prevent potential complications from developing, but the goal should be to get off medications if possible.

This study is important as it shows there is a potential window available without severe consequences for people to adopt lifestyle changes to reduce the effects of hypertension before high blood pressure medications are necessary. To quote the study statement, “The consequences of delaying effective hypertension treatment for up to a year were small - a two-day reduction in quality-adjusted life expectancy - according to a study by University of Chicago researchers published online for the Journal of General Internal Medicine. But as the delay gets longer, the damages multiply. A ten-year delay decreased life expectancy by almost five months.”

While no mention is made about cholesterol and statins, this can be a good thing as too often this is an automatic thing for doctors to prescribe especially when diabetes and hypertension exist in the same patient. If lifestyle changes can be accomplished within one year, then it should also be possible to avoid the need for statins as the cholesterol readings generally follow the blood pressure readings brought on by lifestyle changes.

The study also emphasized the importance of working with the patients to learn how to make the lifestyle changes and receive the support for making them. The American Diabetes Association (ADA) recommends only allowing a three-month trial of medication-free lifestyle therapy for patients with moderately elevated hypertension. This is a good reason for doctors to know of this study and allow the patients up to a year for making the lifestyle changes.

This study argues that caregivers should work with patients to help them gain the knowledge and develop the necessary skills gradually rather than rushing to drug treatment, especially if their blood pressure is only mildly elevated. It suggests that patients and providers "have more time," the authors write, "at least up to one year, to focus on diabetes self-management and lifestyle modification."”

The ideas put forth from this study are needed, but I would agree that sometimes it might be necessary for medications to be used when the test results are in excess of the upper limits. Patient safety should be exercised to bring diabetes and hypertension under good management while the patient is taught how to use and manage lifestyles changes to the fullest.

2 comments:

Gretchen said...

The problem is that "lifestyle changes" usually mean going on a low-fat, high-carb diet that will lower LDL but also lower HDL so the important ratio won't change.

Also, diet has only a small effect on cholesterol levels.

Bob Fenton said...

Thanks Gretchen for pointing out a mistake. Most people do think only low-fat, high carb diets. I am probably one of a few that believe in low to medium carb, and medium to moderately high fat menus.

I did add my link to my prior lifestyle changes blog to cover the types of lifestyle changes I believe in.

I just found this interesting, as with most people with hypertension and diabetes, most doctors will insist on prescribing statins and it was refreshing to see another view on holding off on medications.