February 5, 2020

expert reaction to lifestyle changes after going on statins or blood pressure drugs

Research, published in the Journal of the American Heart Association, reports on the benefits of heart healthy lifestyle choices alongside statins or blood pressure drugs.

Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“It is very important to stress that this study does not show that blood pressure tablets or statins cause people to gain weight or take less exercise. In this study, the people who were started on preventative medications were already heavier and less physically active. This might of course explain why they were prescribed the medications in the first place.

“To prevent heart disease most effectively, it is important for all of us to do more physical activity, eat a heart healthy diet, not smoke, and maintain a healthy weight. In addition, medications such as blood pressure tablets and statins can further reduce risk of heart disease when used in the right people.  The decision whether to take such medications needs to be shared between the patient and the doctor after an open discussion about the benefits of these tablets, balanced against any risk of side effects.

“The results of this study do not provide any evidence that blood pressure tablets or statins cause weight gain or reduce physical activity.”

Prof Sir Nilesh Samani, Medical Director at the British Heart Foundation, said:

“This study shows that the use of statins and blood pressure-lowering treatment is associated with reduced physical activity and an increase in body weight, but also less smoking in those prescribed these treatments.

“Because this is an observational study, it is difficult to tease out cause and effect.  However, the important message is that the use of drugs to prevent heart and circulatory diseases is not a substitute for maintaining a healthy lifestyle.”

Prof Peter Sever, Professor of Clinical Pharmacology & Therapeutics, Imperial College London, said:

“Interesting findings from observational study on lifestyle changes in relation to initiation of antihypertensive drugs and statins.  Very small increase in body mass index (of doubtful clinical significance) in initiators compared with non-initiators, best explained by a reduction in exercise profile.  The small adverse effects were countered by a beneficial reduction in alcohol consumption and number of cigarettes smoked in those initiating drug treatment.

“These findings emphasise the importance of maintaining lifestyle advice to patients initiating drug treatment, with the message that drug treatment of raised blood pressure and elevated cholesterol is not a substitute for changes in lifestyle.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“This is an interesting observational study but it cannot prove a true cause and effect.  If findings are taken to have some credibility, they should not be taken to mean people adopt overall less healthy lifestyles when they start blood pressure or cholesterol medications.  I say this since the sizeable number of people who quit smoking, and cut alcohol could outweigh the harms of any slight increases in BMI, which equates to roughly ½ a kilogram difference, or slight reductions in activity.  There has also been some previous evidence from RCTs¹ that statins might increase weight ever so slightly (<1/3 of a kg), which could be part of the explanation.  But overall, net health changes appear positive.

“If we link these new findings to what we already know, it appears more should be done to help people improve their weight and activity when they start new drugs, as any positive changes they make will further lessen people’s risks and their quality of life, so a win-win.  Fortunately, there are now better evidence based ways to help people lose and sustain weight loss and we can as a profession help communicate lifestyle messages much better.”

1 https://www.ncbi.nlm.nih.gov/pubmed/25262344

Dr Riyaz Patel, Associate Professor and Consultant Cardiologist, Clinical Lead for CVD Prevention, Barts Health NHS Trust, said:

“This is a large observational study, which is useful to an extent in understanding what happens to people’s risk factors over time.

“However the findings are only associations and do not demonstrate that people who start cholesterol or blood pressure medications intentionally became less active or eat poorly.  There are many reasons why these people may have put on weight and become less active, not all of which are accounted for and they may have been on that trajectory already.  The study is also not representative, with a very select mostly white female population.

“What we can take from the study is that there is always scope to continue efforts to improve our lifestyle factors, in parallel to taking medications, when trying to lower heart attack and stroke risk.”

Mr Hugo Pedder, Senior Research Associate in Statistical Modelling at the Bristol Medical School, University of Bristol and Statistical Ambassador to the Royal Statistical Society, said:

“It’s unclear from the study design whether those who initiate taking medications go on to have unhealthy lifestyles, or whether those who have unhealthy lifestyles initiate taking medications.  The approach the authors use to account for this doesn’t seem like a sound approach to me, and is likely to be affected by participants who dropped out of the study.

“The questions used to measure unhealthy lifestyles are self-reported.  Given that people are known to under-report their true alcohol consumption and cigarette use, the answers given may not be reliable and they could bias the analysis.”

‘Lifestyle changes in relation to initiation of antihypertensive and lipid-lowering medication: A cohort study’ by Maarit J. Korhonen et al. was published in the Journal of the American Heart Association at 10:00 UK time on Wednesday 5 February 2020.

DOI: 10.1161/JAHA.119.014168

Declared interests

Prof Tim Chico: “No conflicts.”

Prof Peter Sever: “I’ve received grant funding, honoraria for speaking and consultancies from Pfizer, Amgen and Servier.”

Prof Naveed Sattar: “Have consulted for Amgen and Sanofi.”

Dr Riyaz Patel: “Funded by the BHF.  Received honoraria and consulted for drug companies making new cholesterol treatments.”

Mr Hugo Pedder: “I don’t have any conflicts of interest to declare for this.”

None others received.