The primary preventive prescription of a drug leads many patients to careless behaviors with regard to their lifestyle. Instead of continuing to eat a healthy diet, exercise, and lose weight, many patients reduce their physical activity and gain weight. This can cancel out the effect of the prescribed medication.
In the primary prevention of cardiovascular diseases, “conservative” therapy is the first priority. In concrete terms, this means healthy nutrition, sport, weight loss, smoking cessation, and less alcohol. It is not uncommon that the prescription of a drug is also necessary to control cardiovascular risk. For some time now, however, there has been evidence that patients neglect their lifestyle as soon as they take a pill. The rationale behind the behavior is: "I can sit back, as the medication will fix the problem". Epidemiologists from Finland have now analyzed data from a large-scale long-term health study ("Finnish Public Sector Study") to get to the core of this suspicion.
The researchers were able to draw on data from over 40,000 employees (average age: 52 years, 84% female, 50% overweight) from the public sector in Finland. None of the test subjects suffered from cardiovascular disease at inclusion. In the study, which ran from 2000 to 2013, the participants were asked once at the beginning and then again after about 4 years about their lifestyle, current body weight, physical activity, and tobacco and alcohol consumption. Using a database from the Finnish National Health Insurance Fund, the researchers were able to find out which participants started taking an antihypertensive or statin during the course of the study.
Based on this, they divided the test subjects into three groups: those who were newly prescribed with such a drug during the observation period (11%), those who did not receive any drug during the course of the study (56%), and those who were already taking an antihypertensive or lipid-lowering drug at the start of the study (33%). The researchers then investigated how the prescription of such drugs affected the lifestyle of the study participants.
After about 4 years, it was found that people who were re-prescribed a drug to lower blood pressure or high lipid levels became more inactive (-0.09 metabolic equivalents in hours/day [METs]) and gained more weight (BMI: +0.19 kg/m2) than those who received no drug. The weight gain seemed to affect people who were previously of normal weight. They were almost twice as likely (+82%) to gain weight after the prescription of a drug. In people who were obese at the beginning, the risk was still 37%. Study participants who were physically inactive at the beginning of the study became even more inactive with a 16% probability when they were prescribed with a drug. In people who were already moving a lot at the start of the trial, the risk of inactivity was only half as high (+8%).
The researchers have also recorded how the prescription of blood pressure or lipid-lowering drug affects the cigarette and alcohol consumption of the test subjects. A positive development was observed here. For example, people who received a new drug reduced their tobacco consumption by an average of 0.34 cigarettes per day compared to untreated persons. The probability of completely stopping smoking was 26%. The prescription of blood pressure or lipid-lowering drug also reduced alcohol consumption by about 1.9 grams of alcohol per week.
The research team also compared how people who had taken medication at the start of the study changed their lifestyle. Compared to untreated persons, this group of patients also tended to be more prone to physical inactivity (-0.08 METs) and weight gain (BMI: +0.08 kg/m2). The likelihood of being overweight was similar to that of those who received a drug for the first time (81%).
The study thus proves that the prescription of blood pressure or lipid-lowering drug in primary prevention often tempts people to let their healthy lifestyle priorities slide. In other words, many patients believe that they no longer need to live in such a healthy way (less exercise, poorer diet) because they are now taking a new drug that protects them from the disease. However, this carelessness causes patients to do exactly the opposite: they gain weight and cancel out the positive effects of drug therapy. It is therefore important to point out to all patients when they are prescribed with a drug that a healthy lifestyle must remain part of the therapy in order to achieve an optimal result.
Interestingly, the researchers were also able to show that cigarette and alcohol consumption decreased after the prescription of an antihypertensive or statin. It is likely that the patients were well informed by their physicians. The prescription of a drug does not therefore always have to be accompanied by a neglect of lifestyle. It probably depends on how much priority physicians give to the individual lifestyle factors in a patient interview. The study shows that it is important to motivate patients at the beginning of therapy and throughout the course of treatment to do more sport and change their diet in order to lose weight and reduce their cardiovascular risk.
Unfortunately, dietary habits were not included in this study. It is therefore not clear whether only less exercise or in addition a poorer diet contributed to weight gain. Furthermore, no blood pressure and lipid profiles were collected. It is therefore uncertain to what extent the effect of the drugs was really affected by the deterioration in lifestyle.
Source:
Korhonen M et al. Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid‐Lowering Medication: A Cohort Study. Journal of the American Heart Association. 2020;9:e014168. Originally published 5 Feb 2020