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Too few use cholesterol-lowering drugs

Many Latinos with high cholesterol not managing condition


Half of adults who could benefit from cholesterol-reducing drugs that lower the risk of heart attack and stroke are not using them, according to a new study by the Centers for Disease Control and Prevention – and Latino patients are among the most at risk.

The CDC reported that more than one-third of American adults, or 78 million people, are eligible to take medications to reduce their cholesterol level, but nearly half of them aren’t taking the drugs. This was particularly true among blacks and Latinos.

Dr. Ricardo Vargas, a family practitioner with Novant Health Lakeside Primary Care in Locust, North Carolina, said he is not at all surprised by the findings.

“I see it every day in my practice,” he said. “It’s human nature. When patients have a problem such as pain, they take medication for it. With cholesterol, it’s a much harder sell. Patients don’t feel and see the consequences of high cholesterol, so they don’t invest in their health. This is the primary reason, in my opinion, why Latinos are not taking cholesterol medication.”

High cholesterol is controllable through drugs and lifestyle changes, and it matters for a healthy heart. It is one of the major risk factors for heart attack, stroke and coronary heart disease, according to the American Heart Association. About 800,000 Americans die from heart disease each year.

Overall, the CDC data shows that fewer Americans have high levels of cholesterol. A greater number of Americans are also using statins and other cholesterol-lowering medications. Research shows nearly 28 percent of adults 40 and older used prescriptions to lower cholesterol in 2011 and 2012 compared to 20 percent in 2003 and 2004.

While progress is being made in managing cholesterol levels, the report showed that results varied among different groups of Americans. Researchers said that nearly 40 percent of blacks are eligible for treatment, yet 54 percent of these eligible individuals were not taking drugs to lower their risk of disease.

In comparison, 38 percent of whites are eligible for cholesterol-lowering treatment and 42 percent of this group took no drugs.

About one-quarter of Mexican-Americans might benefit from medication, but nearly 53 percent aren’t taking any, according to the report.

Another study by the American Heart Association found that nearly half of all Latinos are unaware they have even have high cholesterol. Among those that were aware of their cholesterol levels, less than 30 percent received treatment.

“We know that Latinos disproportionately have high cholesterol,” Vargas said. “It is critical that we reach them, but many Latinos lack access to health care.”

Many Latinos are not aware or not screened for high cholesterol because of this lack of access to primary care providers, Vargas said. Latinos also may prefer Spanish-speaking providers, in order to communicate with them and develop a trusting bond.

“For an acute problem, they will not discriminate with a visit to the emergency room for needed care, but in other instances, they want to develop a relationship with their doctor,” he said.

Another barrier to cholesterol screening is economic. “Many Latinos are not likely to carry health insurance or are underinsured,” Vargas said. “Many pay for office visits and testing in cash.”

But Vargas said it is important for Latinos to get screened. As a demographic group, Latinos have a genetic predisposition for low good cholesterol and high bad cholesterol profiles, a problem which leads to coronary heart disease and cardiovascular disease, leading killers of all Americans.

Researchers in the Heart Association study found that high cholesterol was more prevalent in Hispanic men than women, at 44 percent and 40.5 percent respectively. Younger adults, women, the uninsured, people with low incomes and recent immigrants were less likely to have their cholesterol in check.

Vargas said the U.S. Preventive Services Task Force guidelines recommend cholesterol screenings for men age 35 and older and women 45 and older. However, among the Latino population, Vargas said he believes that people in their 20s might benefit from lipid testing as well.

As the Heart Association study found, Hispanic women are more likely to not manage their cholesterol properly. Vargas attributed this to both cultural and economic reasons. “Latino women keep the household together,” he said. “They put their families first, sometimes to their detriment. They don’t want to burden other family members and, as a consequence, they can disregard their own health.”

“High cholesterol is something we can do something about,” Vargas said. “The medical community needs to effectively communicate the risk to Latinos. We need to communicate it to them in a language they understand and translate the numbers so they understand the risk.”

The most commonly used drugs to control cholesterol are statins. In fact, the CDC reported 90 percent of people treating their cholesterol blood levels with medication took these pills. Some people might be reluctant to use the drugs because of side effects such as muscle pain or weakness.

“Statins are the most effective way to treat high cholesterol,” Vargas said. Some barriers to using the lifesaving medications exist among Latinos according to the doctor.

Culturally, Latinos may be reluctant to take medications. “There is suspicion about the pharmaceutical industry and need for medication,” Vargas said. “This is why a doctor’s intervention is critical because there is a trust and respect for a doctor’s recommendation.”

Some patients are worried about the cost of the medicines, but Vargas said is the concern is unfounded. “Most statins are generic and therefore affordable. They also work well,” he said. The pharmaceutical industry will often help those who are unable to afford their drugs and the doctor said he provides coupons to patients to help pay for their medicine.

It’s also important to follow doctor’s orders when taking statins and other medications to manage cholesterol.

Lifestyle changes such as increased exercise, a heart-healthy diet and weight loss can also improve cholesterol. However, CDC researchers that, among all people who were candidates for cholesterol lowering treatment, about 47 percent reported making lifestyle changes, but about 36 percent did not.

Novant Health has some tips on achieving heart healthy diet goals, including:

  • Limit saturated fat intake to no more than 5 or 6 percent of total daily calories. Saturated fat is in meats and dairy or plant products such as coconut oil.
  • Avoid trans fats. Also known as partially hydrogenated oil, trans fats are in fried foods and store-bought baked goods.
  • Eating more fruits and vegetables instead of fatty, calorie-dense foods and controlling portion sizes can help reduce cholesterol.
  • Exercising regularly must also be a part of improving heart health. According to the CDC, only about 14 percent of Latinos meet the recommended levels of physical activity which are 150 minutes a week of moderate aerobic activity such as walking or 75 minutes a week of vigorous exercise such as running.

While the traditional Latino diet isn’t inherently bad, in some instances, it relies on high carbohydrates and low protein, Vargas said. An obstacle to a healthier diet can often be the time and cost required to make better meals, he added. “It’s cheap and easy to eat badly, and more expensive and time-consuming to eat healthy.”

Vargas stressed the importance of being physically active. Find time to exercise four times a week for 30 minutes to 45 minutes a day. “People need to be creative and incorporate more activity in their schedules,” he said. “Park farther from an entrance. Take the stairs, rather an elevator. It all adds up.” 

Through its Million Hearts Initiative, the federal government wants to raise awareness and prevent 1 million heart attacks and strokes. One of its targets is getting 65 percent of Americans to better manage their bad cholesterol by 2017.

There was some good news. The American Heart Association study found that treatment was effective in 64 percent of the Latinos treated, which indicates that heightened awareness of cholesterol risk and its management can help reduce these harmful levels. 

Find additional information on how you can help meet these goals and improve your health at NovantHealth.org/Remarkable You.





Published: 2/11/2016