When people deemed at risk for coronary heart disease and stroke start taking medications to prevent those cardiovascular diseases, they often let some of their heart-healthy habits slide, according to a Finnish study published Wednesday in the Journal of the American Heart Association.
Specifically, the researchers found that after people are given medications to lower their blood pressure or cholesterol, they tend to become less physically active and to gain weight.
These are troubling findings, for they suggest that recent — and controversial — efforts to expand the use of drugs like statins to people at low risk for cardiovascular disease may not lead to the predicted widespread health benefits.
“Medication shouldn’t be viewed as a free-pass to continue or start an unhealthy lifestyle,” said Maarit Korhonen, the study’s lead author and a senior research at the University of Turku, in a released statement.
Why and how the study was done
As Korhonen and her colleagues point out in their paper, behaviors that support a strong cardiovascular system — such as exercising regularly, following a heart-healthy diet and maintaining a healthy weight — are key to preventing cardiovascular disease, whether or not medications have been prescribed.
Yet some recent studies have suggested that people who use medications for lowering blood pressure or cholesterol (statins) tend to engage in less physical activity and consume more calories than those not prescribed the drugs. They also tend to gain weight faster.
Korhonen and her colleagues decided to take a closer look at whether starting preventive medication for the primary prevention of cardiovascular disease (before signs of the illness develop) helps to encourage people to make healthy lifestyle changes — or acts as a substitute for those changes.
To do that, the researchers analyzed questionnaire data collected from 41,225 public-sector workers in Finland who had not been previously diagnosed with heart disease or stroke. The data included information about the workers’ body mass index (BMI), physical activity levels, alcohol consumption and smoking history. The average age of the workers was 52 when the study started, and more than 80 percent were women.
Each participant was then surveyed twice more at four-year intervals between 2000 and 2013. The researchers also obtained pharmacy records for the participants. Those records showed that 8,837 of the workers (10.8 percent) had been prescribed blood pressure- or cholesterol-lowering medications for the primarily prevention of cardiovascular disease at some point after they filled out the first questionnaire.
When the researchers compared the people who started on the preventive medications with those who didn’t, they found some interesting lifestyle differences.
The people put on the medications were more likely to have reduced the average daily amount of time they spent exercising, regardless of how active they had been at the start of the study, and were 8 percent more likely to have become totally sedentary.
They were also 82 percent more likely to have developed obesity.
Those findings support the hypothesis that some people substitute the medications for healthy habits, the researchers conclude.
On the other hand, the data revealed that people who had started on the medications were 26 percent more likely to have quit smoking than those not on the meds. They were also less likely to have cut back on their alcohol consumption, although there was no difference in the prevalence of heavy drinking between the two groups.
Those findings — particularly the smoking one — support the hypothesis that some people use the initiation of medications for reducing the risk of cardiovascular disease as a complement to a healthier lifestyle, the researchers note.
People — particularly women — do tend to gain weight when they stop smoking, but the researchers say that factor does not explain the weight increase observed in the study. The people who took medications and stopped smoking gained more weight than those who didn’t take medications and stopped smoking.
Limitations and implications
The study comes with important caveats. It is an observational study, and thus can’t prove a causal relationship between taking blood pressure- and cholesterol-lowering drugs and changes in lifestyle habits. Other factors, not identified in the study, might explain those changes.
Also, the participants were mostly white, Finnish women. The findings may not be applicable, therefore, to other groups of people.
Still, at the very least the findings should serve as a reminder that taking medications to prevent disease should not be viewed as a substitute for a healthy lifestyle.
“People starting on medications should be encouraged to continue or start managing their weight, be physically active, manage alcohol consumption and quit smoking,” Korhonen stresses.
FMI: You’ll can read the study in full at the Journal of the American Heart Association website.