AHA: Biggest Hypercholesterolemia Challenge Is Nonadherence

ORLANDO, Nov. 11 -- Researchers here said they are concerned that, despite having treatment modalities capable of lowering cholesterol to levels that are protective against heart disease, it is still a struggle to get patients to take the medications.
"The number one epidemic in medicine today is patient compliance," said Lori Mosca, M.D., of New York-Presbyterian Hospital and Columbia University, at an industry-funded symposium held in conjunction with the American Heart Association meeting.
"Studies show that only about 60% of patients ever fill a [prescription for a cholesterol-lowering drug] and after six months, compliance with taking the medicine has dropped off a third -- so that after 6 months only 40% of the patients originally given the prescription are taking the medicine," she said.
The burden for getting treatment to patients does not fall only on patients, Dr. Mosca said. She said that almost all primary care physicians and cardiologists and more than half of gynecologists are aware of guidelines for controlling cholesterol, high blood pressure, and women's treatment issues. But fewer than half of those doctors can say that they actually follow the guidelines.
Dr. Mosca suggested that to improve compliance, doctors need to:
Improve communication techniques.
Simplify treatment regimens.
Follow up on adherence via telephone, mail, and e-mail.
Enlist support of patients' spouses.
Use compliance strategies such as contracting.
"In practice the guidelines are not followed," said Benjamin Ansell, M.D., of the David Geffen School of Medicine at the University of California, Los Angeles.
Dr. Ansell said that compliance isn't just an American problem. In Canada, he noted, the best compliance with statins shows a 60% uptake of the drugs. In Europe, less than a third of women and less than half the men are at cholesterol goals.
"We are leaving the job unfinished," he said, especially in treating women. He said less than one in five women are at their cholesterol goals.
The chairman of the symposium, Antonio Gotto, Jr., M.D., D.Phil., of Weill Cornell Medical College at Cornell University in New York, noted that "about 57% of people who have coronary heart disease equivalents are using a statin."
While there are already many drugs that can lower cholesterol, more are being developed, said Michael Davidson, M.D., of the University of Chicago.
He reviewed a number of areas of development including the human apolipoprotein B100 antisense inhibitor known as ISIS 301112; the sqaulene synthase inhibitor lapaquistat; the antiflushing agent MK-0524 that may make niacin a more viable agent; new drugs that increase high-density lipoprotein; and the lipoprotein associated phospholipase A2 (Lp-PLA2) inhibitor known as SB677116.
Dr. Davidson said the goal of these drugs is to enhance cholesterol lowering while minimizing side effects, thus giving patients another reason to take their medications.