A clinician’s clear explanation of statin use that goes beyond numbers is essential to a patient’s understanding of the benefits and risks of this therapy, according to a report published March 30 online in the Journal of the American College of Cardiology.
Lead author Seth Martin, MD, MHS, and colleagues offer some tips, including the following, on how to conduct this complicated discussion, for which they suggest allotting extra time or spreading over several visits, if necessary:
Avoid focusing on a number. Patients with borderline scores may benefit from additional testing such as coronary calcium CT scans that can clarify their risk.
Contextualize risk. Provide perspective on the patient’s risk score by comparing the patient’s risk for heart attack or stroke to someone of the same age, gender, and race who has optimal risk factors.
Address the five M’s of statin side effects: Memory, metabolism, muscle, medication interaction, and major organ effects. Use simple arithmetic to convey the difference between expected therapeutic value versus possible harm as a net benefit.
Discuss the association between diabetes and statin use. Emphasize that even those who develop diabetes after initiating statin therapy derive the same or even greater benefits in reducing their cardiovascular risk.
Evidence that statins impair memory function is limited. Patients should be reassured.
Severe muscle damage from statin use is very rare. Although muscle effects should be monitored closely, patients should be informed that minor aches and pains are common yet often benign.
Pay attention to news media. Understanding the messages about statin risk to which patients are exposed can help clinicians address them.