Although a heart-healthy lifestyle is potent medicine in the management of cardiovascular risk, a large Finnish study finds that many — but not all — patients forgo healthy habits after starting a statin or antihypertensive medication.

Researchers studied 41,225 public-sector workers free of cardiovascular disease at baseline who completed at least two surveys in 4-year intervals from 2000 to 2013.

Results show that body mass index (BMI) ticked up among all participants, but the average increase was larger among those starting an antihypertensive or statin medication (adjusted difference, 0.19; 95% CI, 0.16 – 0.22).

Participants who started medications were 82% more likely to become obese (adjusted odds ratio [OR], 1.82; 95% CI, 1.63 – 2.03).

Medication initiators were also more likely to cut back on physical activity (adjusted difference, –0.09 MET h/day) and were 8% more likely to become physically inactive (adjusted OR, 1.08; 95% CI, 1.01 – 1.17), regardless of their baseline activity.

“My concern when I started this study was that people would think, ‘now I don’t need to worry about my lifestyle because the medication will do all the work for me.’ Our study supports that idea,” lead author Maarit J. Korhonen, PhD, a senior researcher at the University of Turku in Finland, said in an interview.

The study is better than many that have been done before because it looks at lifestyle changes over time but, unfortunately, the results are not that surprising, Russell Luepker, MD, the Mayo Professor of Epidemiology and Community Health at the University of Minnesota in Minneapolis, told | Medscape Cardiology.

“People who get started on medications for their increased cardiovascular risk may let other things slide some,” he said. “We live in a pill culture.”

The study was published this week in the Journal of the American Heart Association.

Although the data provide more support for the belief that initiation of preventive medication is more likely to substitute for a healthy lifestyle than complement it, there were some positive signs.

Baseline smokers who initiated statin or antihypertensive therapy were 26% more likely to quit smoking than those who remained untreated (adjusted OR, 0.74; 95% CI, 0.64 – 0.85).

Average weekly alcohol consumption went down more among medication initiators than non-initiators (–1.85 g/wk; 95% CI, –3.67 to –0.14), although the odds of heavy drinking were similar in the two groups, the authors report.

Korhonen struggled to explain why some healthy habits were adopted and others ignored. Although smoking cessation often results in weight gain, this did not explain the increased BMI finding. Smokers who took medications and quit gained more weight than smokers who quit but were untreated.

Although frustrating for physicians, the divergence is “probably not a wash,” Luepker said. “I think in the large trials of statins, some of this happens, but the drugs are more powerful.”

“What this reinforces to me is that we’re good at prescribing things but not very good at making people successful in changing their health behaviors, and these things are additive to the drugs.”

That said, Luepker observed that 15-minute physician appointments do not lend themselves to detailed lifestyle discussions and that more support staff and insurance reimbursement are needed to enhance lifestyle-modification counseling.

It is not known whether study participants were given information or counseled on healthy lifestyles but, in general, there is a recommendation that patients see a nurse regularly, “maybe once a year,” after being prescribed statins or antihypertensive medications, Korhonen said.


REFERENCE: Korhonen et al:  Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid‐Lowering Medication: A Cohort Study;