Healthy lifestyle habits are still vitally important after starting medicines to control blood pressure or cholesterol, doctors have warned this morning in the Journal of the American Heart Association. Their research* showed that people at risk for heart disease and stroke who started taking antihypertensives or statins gained weight and took less exercise than those not on the drugs.
They studied 41,225 men and women aged ≥40 years participating in the FPS (Finnish Public Sector) study, who were free of cardiovascular disease (CVD) at baseline and had responded to at least two consecutive surveys administered at four-year intervals in 2000–13. They used pharmacy claims data to ascertain participants’ use of medication including antihypertensives, diuretics, β-blockers, calcium channel blockers, renin–angiotensin system blockers; and statins. They then compared changes in body mass index (BMI), physical activity, alcohol consumption, and smoking between the 8,837 people who had initiated antihypertensive medications or statins and the 46,021 who had not started taking those drugs.
The researchers reported that compared with non-initiators, BMI increased significantly more in people who initiated medication (difference in change 0.19), physical activity declined (‑0.09 metabolic equivalent of task hour/day), and they were significantly more likely to become obese (odds ratio, OR 1.82) and physically inactive (OR 1.08). However, medication initiation was also associated with greater decline in average alcohol consumption (‑1.85g/week) and higher odds of quitting smoking (OR for current smoking in the second survey 0.74).
They said their findings show that because initiation of antihypertensive or statin therapy appears to be associated with some unfavourable lifestyle changes as well as favourable changes, expansion of pharmacological interventions towards populations at low CVD risk might not necessarily lead to the expected benefits at the population level – so “more effective measures are needed to support the recommended lifestyle change in relation to the initiation of pharmacologic interventions for primary prevention”.
They commented: “Medication shouldn’t be viewed as a free-pass to continue or start an unhealthy lifestyle… People starting on medications should be encouraged to continue or start managing their weight, be physically active, manage alcohol consumption and quit smoking.”
*Korhonen MJ, Pentti J, Hartikainen J, et al. Lifestyle changes in relation to initiation of antihypertensive and lipid-lowering medication: a cohort study. J Am Heart Assoc. 2020; 9: e014168. DOI: 10.1161/JAHA.119.014168