Taking the right medications really matters

Now this article reports on a wonderful study – No ‘Healthy Adherer Effect’ Found In Post-MI Patients

Heart attack survivors who conscientiously take prescribed statins or beta-blockers live longer than those who don’t, but that’s not so for compliant patients on calcium channel inhibitors, according to researchers here reported.

The observational study suggested the so-called “healthy adherer effect” was not a factor for post-MI patients taking calcium channel blockers. It also confirmed that statins and beta-blockers work in the “real world” as well as in clinical trials, said David A. Alter, M.D., Ph.D., of the Institute for Clinical Evaluative Sciences.

Poor adherence to statins was associated with a 25% increased mortality risk, while poor adherence to beta-blockers increased the risk of dying by 13%, Dr. Alter and colleagues reported in the Jan. 10 issue of the Journal of the American Medical Association.

If the healthy adherer effect was involved in the observed mortality benefits for statins and beta blockers, there should have been some mortality benefit seen among adherent patients on calcium channel inhibitors as well, the authors reasoned.

But adherence to calcium channel inhibitors-”considered a control given the absence of clinical trial-proven survival benefits”-was not significantly linked to mortality risk, they found.

I always teach the importance of secondary prevention. Now this term is used differently (as a quick Google search has taught me). When I teach secondary prevention of coronary artery disease, I refer to treating patients with known disease to lessen progression and recurrent events.

As I read the data, this secondary prevention is often cost saving. I know of no experts who argue against secondary prevention, while the debates on primary prevention are heated.

This brilliant study shows that it is actually the medications – and not the personality of those who adhere to medication schedules – that causes the mortality benefits.

We should not extrapolate these results to primary prevention. The issues involved in primary prevention are much more complex.