ILEP President, Professor Maciej Banach, Medical University of Lodz and University of Zielona Góra, Poland, who initiated these recommendations, said: “
In addition, we know that, in fact, most adverse events diagnosed with statins should not be attributed to statin treatment. Up to 70% of symptoms can be attributed to a psychological phenomenon known as the ‘nocebo’ or ‘drucebo’ effect. “
‘Nocebo’ refers to adverse side effects that a patient may experience when taking a pill that does not contain the active ingredient – an inert tablet.
‘Drucebo’ refers to the difference in side effects experienced when a pill containing the active ingredient is taken knowing it is a statin or being blindsided as to whether it is a statin or an inert tablet. This provides insight into the extent to which symptoms may be due to mere expectation.
Professor Banach continued: “The ‘nocebo/drucebo’ effect is when patients expect that they will experience side effects from the statin that cause them to actually experience these symptoms.
Their knowledge was obtained from the internet, leaflets, friends and family and other sources, and the most common side effects were muscle pain and liver complaints. It can cause them to stop receiving treatment and, as a result, increase their risk of heart disease, stroke, and death. “
Statins are among the most commonly prescribed drugs, and there is clear and strong evidence that statin treatment makes a significant difference in preventing cardiovascular disease and death from it.
A recent meta-analysis found the prevalence of statin intolerance to be less than 10%. However, up to one in two patients stop taking statins, reduce their dose, or take them infrequently because they believe they are the cause of the side effects.
The paper’s first author, Dr Peter Penson, a Reader in Cardiovascular Pharmacology at Liverpool John Moores University, Liverpool, UK, said: “This is the first paper that explicitly mentions the nocebo/drucebo effect.
It offers practical and evidence-based recommendations that we hope will be of use to physicians in improving patient-centered care in at-risk populations. cardiovascular disease but experience side effects from their medications. “
“The benefits of a statin are not immediately seen by the patient, while the side effects are more obvious, and so many patients stop taking the statin, thereby at risk of serious illness or death .. “
The Personalized Lipid Intervention Plan (PLIP) proposed in our article helps patients understand the rationale for their treatment, the major benefits, including that statins can prolong their lives, and potential harms.
This allows patients to make well-informed decisions about starting and continuing treatment. The PLIP also summarizes important lifestyle tips to help them reduce their risk of heart attack and stroke.
“We hope this document will facilitate joint decision-making between patients and prescribers. The recommendations acknowledge that the vast majority of patients can safely take statins and that the benefits far outweigh the potential risks of side effects.
They offer advice on improving adherence to statins, and make recommendations for identifying and managing a relatively small number of patients with true statin intolerance. ”
ILEP is comprised of more than 70 experts worldwide who contributed evidence and recommendations to the current paper, and who agreed to the recommendations. Recommendations include:
- Healthcare professionals should consider the nocebo/drucebo effect when they first prescribe statins and inform patients about the rationale and benefits of therapy.
- A Personalized Lipid Intervention Plan (PLIP) should be used to help with this process
- It estimates a patient’s 10-year risk of cardiovascular disease with and without statin therapy, and provides clear information about harmful side effects, including common muscle symptoms. but rarely caused by statins
- Periodic follow-up to check the safety and effectiveness of the therapy
- How to manage patients with no biomarkers for abnormalities and tolerable statin-associated muscle symptoms (SAMS)
- How to manage patients with abnormal biomarkers and/or intolerable SAMS
- strategy for the management of patients with complete statin intolerance.
how to effectively diagnose statin intolerance and rule out the nocebo/drucebo effect
It also discusses the evidence for non-statin drugs that can be used to lower cholesterol.
Dr. Penson concludes: “It is important for physicians to apply their own judgment in the context of the health care system in which they work and their knowledge of each patient when deciding whether to implement specific recommendations. can or not. However, if prescribers find the advice helpful, we encourage them to share it with their colleagues. “
The authors and ILEP plan to disseminate their guidelines through national and international training for healthcare professionals, presentations at conferences and webinars, as well as through conferences interviews, podcasts and lectures on the ILEP website and other specialist websites worldwide.