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Marking aging with the pill bottles: do they accumulate with age?

Part of the physiotherapy assessment is a medication review. You may not think this is an important piece for physiotherapists to know but ANY medication a person is on carries a risk for side effects that may effect the muscles in your body. Many medications have side effects that include dizziness, fatigue, nausea and muscle aches and pains.

Working with a 50+ demographic, being on meds for high blood pressure or cholesterol are common place. It has gotten to the point where many of my clients don’t even see it as a big deal… because everyone is doing it right?!

But how much do we know about them?
Let’s take a step back and talk about WHY we are on them in the first place.

Cardiovascular Disease … the silent killer.

Cardiovascular disease is the narrowing of the arteries that can, over time, cause blockages in the arteries in your body. These arteries supply blood to all of your organs including your heart and brain. A block in an artery to the heart causes a heart attack, or myocardial infarction. A block in an artery to the brain causes a stroke. A heart attack or stroke can be devastating, leading to time off work, prolonged disability, lengthy hospital stays and sometimes even death. Our risk for both heart attack and stroke increases with age (we have more time to build up those plaques!). So doctors have started to look at ways to PREVENT these blockages from happening in the first place.

We’ve come a really far way! Treatment after heart attack and stroke have gone up exponentially and more people are surviving and thriving after a heart attack or stroke. Ideally you wouldn’t want them to happen at all.

This is where the drugs come in.Pillars

In the medical world we talk about different TYPES of prevention. For the purposes of this article I’m going to discuss two: primary prevention and secondary prevention. These are similar to the STAVE OFF Pillars of Prevention/ Healthy aging

 

Primary prevention is stopping a heart attack or stroke from happening in the first place. Secondary prevention is once it HAS happened, to stop it from happening again.

Keeping your blood pressure and cholesterol in normal anges is one way to prevent the processes that cause these blockages from happening in the first place. There are many ways to do that, medications being one of them. I’m repeating them that medication is ONE of them.
The Heart and Stroke foundation has outlined these wonderfully on their website.

Ways to prevent heart disease include
-> Exercise/ Fitness!
-> Healthy Eating
-> Proper sleep
-> Stress management
-> Medications

If ALL of these are important ways to prevent a heart attack, stroke or complications from either to happen, shouldn’t we be spending an equal time talking about ALL of them?! Serious adverse events RARELY happen from a good workout, a nutritious meal, meditating to reduce stress or getting 8 hours of shut-eye. So why aren’t they just as talked about as some of the medications? Even the Mayo Clinic when it talks about lifestyle factors like the ones I just listed minimizes the impact and says “you know the drill” for preventing a heart attack. But many of us DON’T know exactly what to do!

The benefits, risks and concerns about medications

Here is where having an honest conversation with your doctor is going to be a key part of management of issues with cholesterol or blood pressure.

There is evidence to suggest that the use of statin drugs (that are used to control your cholesterol) have positive effects at reducing your risk of having a heart attack or stroke.
Currently the average length of follow up from a drug trial is about 3 years. I have clients who have been on blood pressure medication for over 20! Clinicians have said that they need better guidance on the use of these drugs for long-term use of aspirin, statins and other heart medications. The long term effects of these medications are still not known, especially for older adults over the age of 75.

A review published this year explores the use of medications for primary prevention of cardiovascular disease in older adults. It showed that there has only been one drug trial that has been done specifically for older adults, one of the highest users of these medications. In this trial, the risk of heart attack and stroke went down from 16.1% to 14.2% with the use of statins…less than 2 percent. Side effects that occur in as many as 5% of cases, or 1 in 20, are diabetes, cancer, and myopathy (muscle weakness – see our normal parts of aging article about weakness!). Once you start these medications, you are on them for the rest of your life. That can be a tough pill to swallow (pun intended haha).

The American College of Cardiologists have guidelines that state that once you have had a heart attack, they recommend the daily use of aspirin, beta blockers, ACE inhibitors and statins. This is the management suggested to prevent another heart attack from happening. It’s a lot!

One of the biggest concerns though … is that even though we are supposed to be taking these medications… we aren’t taking them! We have the prescription and are told by our doctors to take them but only 40% of people who have had a recent heart attack take them on a regular basis. This goes down to 20% if they are prescribed when you haven’t had a heart attack. That means that most people aren’t even taking the medications recommended from their doctors. There is concerns about people being inconsistent with their medications and if this leads to more risk and concerns around safety of taking them in the first place.

Recommendations for our health professionals.

Am I trying to say that we should stop prescribing these medications? NO. But I do think that a costs and benefits discussion needs to take place. I have had clients feel FORCED into taking these meds when they hadn’t tried diet or exercise first. A meta analysis showed that persons who did high intensity exercise had a 35% reduction in heart related events. Compare that to the 2% reduction in the statin trial ….

Prevention of heart attack and stroke is multi-component but exercise, sleep, stress, not smoking are ALL REALLY IMPORTANT talking points and we should be spending JUST AS MUCH time talking about these aspects as the medications.

That is just my two cents and I’m not a doctor but as a physiotherapist, these healthy lifestyle practices are an important component of my initial assessment and my treatment. As clients and patients, having these discussions with your doctors is so so important. Opening up these conversations are up to you.

References:

Barry, A. R., O’Neill, D. E., & Graham, M. M. (2016). Primary prevention of cardiovascular disease in older adults. The Canadian Journal of Cardiology, doi:S0828-282X(16)00093-3 [pii]

Rossello, X., Pocock, S. J., & Julian, D. G. (2015). Long-term use of cardiovascular drugs: Challenges for research and for patient care. Journal of the American College of Cardiology, 66(11), 1273-1285. doi:10.1016/j.jacc.2015.07.018 [doi]

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