Do Preventive Medicines Undermine Healthy Habits?

By CardioSmart News

There’s no question that healthy habits are important throughout life to prevent heart disease. But using medicine to lower blood pressure or statins to lower cholesterol for primary prevention has become more widespread.

After starting these medicines, individuals are more likely to gain weight or be less physically active than those who don’t take them, according to a recent study published in the Journal of the American Heart Association (“Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid-Lowering Medication: A Cohort Study,” JAHA, Feb. 18, 2020).  

In the past, individuals learning they have heart disease or diabetes has been linked to spurring healthy habits, according to study authors.

These habits include:

• Weight loss
• Increased physical activity
• Decreased alcohol consumption
• Smoking cessation

But data over the past 20 years suggest that is no longer the case. Starting in the 2000s, data show people on medicines for blood pressure or cholesterol having lower physical activity. At the same time, there is evidence that people on statins are eating more fat and more likely to become obese than non-users, the authors write. 

This study further examined whether starting preventive medicine hurts or harms healthy habits. Authors reviewed information of 41,225 Finnish adults who did not have cardiovascular disease to start. Participants responded to three health surveys given four years apart from 2000 to 2013. Researchers used pharmacy claims information to determine whether individuals started taking medicine. Of the 8,837 who initiated medicine during that time, 84% were women with an average age of 52.  

Average body mass index (BMI) increased for both groups: those who started medicine and those who did not start. But those who started medication had a bigger increase in BMI. They also had a greater likelihood of being physically inactive. 

Interestingly, the findings show that smokers who started medicine were more likely to quit or smoke less than untreated smokers. In the case of people who smoke, it appears that treatment with drugs supports adopting a healthy habit. Initiators also were more likely to drink less alcohol.

The authors note several limitations of this study. A concern is that the results might not translate to other countries or populations. The population in this study was made up largely of white women. During the study period, a public health campaign in Finland might have affected the participants’ adopting healthy behaviors. In addition, the pharmacy information showed only that a prescription was filled. Authors don’t know whether participants took the medicine or how. Also, the study used self-reported information from surveys. This method could have underestimated obesity, smoking, and alcohol intake. 

Emphasis of a healthy lifestyle comes before prescribing medicine to prevent heart disease, according to clinical guidelines. Adding medicine ought to complement, not derail, the adoption of healthy habits. Unfortunately, this study suggests that starting medications changes behaviors—in bad and good ways. 

People who start preventive medicines might benefit from added support to keep up healthy habits as weight gain or less physical activity may be a challenge for them. Awareness of personal risk factors is one step but not enough to improve healthy habits, authors say. Good areas to focus on would be helping individuals find out what motivates them to make positive changes, shared decision-making, and team-based approaches. 

Still, more research into effective ways to improve health behaviors is needed.