People who most need prescribed heart disease prevention drugs least likely to get them
Millions of 'disadvantaged' Americans least likely to receive recommended medication, Toronto researchers say
Socioeconomic inequities may be preventing millions of people in the U.S. from getting standard medications to prevent heart attacks and strokes, according to Canadian doctors who see it as a warning signal for this country.
Canadian researchers began looking into the issue after American health authorities in recent years expanded their guidelines to recommend that cholesterol-lowering statins may be used to prevent heart disease, and not just treat it, in individuals at high risk because of conditions such as obesity.
"The new guidelines would suggest about 18 million new American adults should take statins," said Dr. Amol Verma, an internal medicine physician and scientist at St. Michael's Hospital, and lead author of the study published in Circulation: Cardiovascular Quality and Outcomes.
"Of those, 66 per cent, so 12 million, are from disadvantaged background. Either they have low education, or they have low income, or they were non-white. This is really important because those are the very groups who are the least likely to have health insurance and they are the very groups who are the least likely to receive recommended medication."
The health-care community in the U.S needs to focus on disadvantaged populations, Verma said, particularly given how the policy debate is centred on reducing health insurance coverage for the most vulnerable members.
"That's very much at odds with what science is telling us, which is we should be thinking about how to expand coverage in these populations."
The findings come as one in 10 Canadians report they don't take recommended medications because of cost. But it's known that coverage of prescription medications reduces disparities between advantaged and disadvantaged groups, such as for diabetes care in Ontario, Verma said.
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"The implications of our study suggest that there is another benefit to the debate in Canada around a pharmacare plan to cover prescription drugs," Verma said. "If we do move to a model where prescription drugs are covered for more people, more people from disadvantaged groups will likely get access to preventative medications like statins, and this would have a benefit here."
Study senior author Dr. Fahad Razak, an internal medicine physician at St. Michael's, said the medications could prevent devastating heart attacks and strokes to individuals and costs to the health-care system.
Both Verma and Razak routinely prescribe generic statins in their daily practice.
For people who have never had a heart attack or a stroke, if you give a statin to a patient for about five years, studies suggest it can reduce the chance of a person having a heart attack or a stroke by about one per cent.
There's also evidence to support the idea that public drug coverage improves access to needed medications in other provinces.
Overcome financial barrier
Earlier this year, Steve Morgan, a professor in the School of Population and Public Health at the University of British Columbia, published a study in CMAJ Open that looks at how older women in the province were less likely to fill prescriptions for statins and blood pressure medications than women who had lower deductibles, because of their spouses' age.
"My study took advantage of the fact that women who are married to older men qualified for better coverage simply because of the age of their spouse," said Morgan. "The differences in access to statins were statistically significant even 10 years after the policy change that affected differences in coverage.
"There are many reasons patients sometimes don't get the medications recommended by clinical guidelines," he added. "Some of those reasons are legitimate — such as patient preference for non-drug approaches to managing risk factors or when a patient experiences side-effects from a drug treatment. Other reasons for not getting recommended therapies are problematic. A primary goal of a universal public drug plan is to ensure that financial barriers aren't one of the reasons."
With files from CBC's Amina Zafar