Advertising Campaigns of Sterol-Enriched Food. An Often Neglected Cause of Reduced Compliance to Lipid Lowering Drug Therapy

Abstract

Adherence to lipid lowering treatment is a matter of crucial importance as it has been proven to reduce long term mortality especially in high cardiovascular risk patients [1]. Unfortunately, studies evaluating adherence to lipid-lowering treatment have shown reduced compliance: early high discontinuation rates, patients (considered as persistent) who do not really follow their drug regimen regularly, and reduced compliance not only for patients receiving drugs for primary prevention, but also for those receiving them for overt cardiovascular disease [2]. On the other hand, many studies have demonstrated the effectiveness of dietary sterols as adjuvant treatment in reducing total as well as LDL cholesterol in dislipidemic subjects. Indeed, guidelines recommend the consumption of sterol enriched food products as a further option, in addition to statin therapy in patients with dylipidemia. But apart from lipid lowering effects, there is also evidence that moderately elevated serum plant sterol levels are independently associated with reduced cardiovascular risk [3], while plant sterol esters have similarly favorable effects on endothelial function in hypercholesterolemic subjects [4]. Understandably, such positive clinical and experimental data and similar recommendations by experts result in a great esteem by health journalists and media, but excessive publicity or promotion can sometimes be misleading or have a negative impact on the patient. On the other hand although the positive effects of sterols are well documented and already adopted from millions of people, many aspects of their biologic actions are still under investigation since even excluding phytosterolemia, phytosterols have also recently been identified in atheromatous plaque obtained from individuals with apparently normal absorption of plant sterols raising the possibility that phytosterols may constitute an atherosclerotic risk factor [5], while it is also clear that customized regimens are expected to improve patient outcomes and minimize costs of treatment since effective lipid-lowering also depends on whether a patient is mainly a synthesizer or absorber of cholesterol. Concerned by the possible effects of a recent and intensive advertising of sterol enriched food products in the Greek market during the last 6 months and co-motivated by the evidence but mainly by the resulted overwhelming pressure exerted by many of our patients who insisted on a switching between lipid-lowering therapy (statins) with sterol enriched food products, we have conducted a survey in the Athens metropolitan area regarding patients’ attitudes towards lipid-lowering treatment options. We interviewed a random sample of 412 dyslipidemic patients currently under statin treatment in an 8 weeks period during the Autumn of 2006, at the peak of the sterol advertising blitzkrieg. All patients were asked to respond to a simple questionnaire during their ordinary medical visit for follow-up and/or drug prescription purposes. The questionnaire included data about the age and sex of the patient as well as questions aiming to evaluate patient’s beliefs regarding lipid lowering treatment. Detailed findings and main questions asked are Cardiovasc Drugs Ther (2007) 21:133–134 DOI 10.1007/s10557-007-6015-5