New research shows that a healthy diet and regular exercise are essential to cardiovascular disease prevention, but patients often forget about this when taking preventive medication. More specifically, when patients begin taking statins and antihypertensive medications, many stop abiding by healthy lifestyle habits, according to a study published in the Journal of the American Heart Association.

What Did the Research Find?

The researchers, who focused on Finnish participants, compared changes in body mass index (BMI), physical activity, alcohol consumption, and smoking between 8,837 initiators and 46,021 non-initiators of antihypertensive medications or statins.

Researchers found that the BMI of patients who started taking medication increased, and physical activity declined. Moreover, the likelihood of becoming obese and physically inactive was higher among initiators.

“When doctors initiate patients on blood pressure or statin medications, they should tell them that it is important to start or continue to manage weight, be physically active, manage alcohol consumption, and quit smoking,” study author Maarit J. Korhonen, Ph.D., says

She clarifies that the study included individuals who did not have cardiovascular disease and were a relatively low-risk population. But the study results showed that, on average, people who started blood-pressure medication gained more weight and decreased their physical activity compared with those who did not start these medications or did not need them.

The study contained one stat that seemed to indicate positive change among initiators — but upon further analysis, it’s not as clear-cut. Those starting medications were more likely to quit smoking than those who were not on medication. But 70% of smokers who started medication continued smoking after the initiation of medication, Dr. Korhonen explains.

And while average alcohol consumption declined among the initiators (versus those who did not initiate medication use), there was no difference in the likelihood of heavy drinking after initiating medication.

“Among initiators, almost 60% with high alcohol consumption before medication initiation continued heavy drinking after the initiation,” Dr. Korhonen says. “Our finding is that at least some patients stop or do not even start practicing healthy lifestyle habits.”

How Can Providers Help Their Patients?

Mary Ann Bauman, MD, a spokesperson for the American Heart Association, says it is important for providers to speak with their patients starting on the medications to motivate them to prevent heart disease. After all, that’s the goal of the medication.

“More people who are taking these medications … are not as high-risk as people who have heart disease already,” Dr. Bauman says. “They should be told about the importance of diet and exercise. It is nice to have this study to point out to patients that this is true.”

So What Should You Tell Your Patients?

There is no single solution that works for everyone. But, in general, “shared decision making, where we actually discuss with the patient what they want to do and are willing to do, is more effective than simply telling people to do something,” Dr. Bauman says. “In some cases, sending reminders by text message and sending approval by text when milestones are reached can be effective,” she adds. A quick check-in call from the provider’s office can be helpful, too, because it shows “there is some accountability and … that the provider is interested and concerned.”

Dr. Bauman also recommends cognitive-behavioral strategies, such as motivational interviewing and multidisciplinary and team-based approaches. “Awareness of the risk factors alone does not seem to motivate people,” so providers must make the proposed lifestyle modifications manageable. “Instead of saying you need to change your lifestyle, maybe suggest cutting out one soda a week,” she says. “There really is no one-size-fits-all here.”