Lifestyle changes are important even if you take medications

Robert H. Shmerling, MD

Senior Faculty Editor, Harvard Health Publishing

A friend of mine takes a statin medication each day to lower his cholesterol. More than once I’ve heard him say “I ate too much! I’m going to have to take an extra pill.”

Never mind that it doesn’t work that way — a single additional statin pill won’t make much difference to his cholesterol or his health. And never mind that you shouldn’t self-adjust the dose of your medications (talk to your doctor before making any changes in medication dosing).

But my friend’s overindulging does bring up the question of whether starting medications for conditions like high blood pressure or high cholesterol might lead people to pay less attention to healthy lifestyle choices. Would my friend have been as likely to overeat before he was started on a statin?

What actually happens to lifestyle changes after medications are prescribed?

The thinking might go like this. If your cholesterol or blood pressure is not ideal, your doctor will likely recommend changes in your diet, regular exercise, and loss of excess weight, as these measures will lower cholesterol and blood pressure in many people. But if that doesn’t work well enough, a medication may be prescribed. Once the medicine is doing its job, it may seem like it’s not so important to continue with the diet and exercise routine.

A new study published in the Journal of the American Heart Association suggests that this way of thinking might be widespread: people with hypertension (high blood pressure) or high cholesterol seem to let their healthy habits slide once they start taking medications.

Researchers collected data on weight, smoking, physical activity, and alcohol use among more than 40,000 adults with no history of cardiovascular disease. Compared with people who were not prescribed medications for high cholesterol or high blood pressure, those who were prescribed medications

  • tended to gain more weight. In fact, they were 82% more likely to become obese.
  • exercised less. They were 8% more likely to be physically inactive.

The news wasn’t all bad. Those starting medications tended to drink less alcohol and to quit smoking more often than those not taking medicines.

It’s not okay to slack off on lifestyle changes like diet and exercise if you’re taking a statin or blood pressure pill

These results can be interpreted in a number of ways. Perhaps people who start taking medications assume they no longer need to be as careful with how they eat or other lifestyle choices. It’s also possible that people who ultimately needed medications were less careful with following a healthy lifestyle even before medications were prescribed — and that may explain, at least in part, why they needed medications in the first place. Or, it could be that those destined to require medication therapy inherited more high-risk genes for future obesity.

Whatever the explanation, people with high blood pressure or high cholesterol should maintain a healthy weight and get regular physical activity, regardless of whether medications are prescribed. In fact, it may be even more important for those who were prescribed medications, because if their conditions were severe enough to warrant a prescription, they may be at higher risk for complications (such as heart attack or stroke) than those able to avoid medications.

The bottom line

For many conditions, a medication can only do so much. Healthy lifestyle habits can improve the chances that a medication will be effective.

For people with high blood pressure, high cholesterol, and many other conditions, medications should be in addition to lifestyle changes, not instead of them. Not only will these lifestyle choices improve the chances your medicines will work to lower blood pressure or improve cholesterol, they come with a long list of other health benefits, such as improved mood, a reduced risk of diabetes, and a lower risk of certain cancers. And if you stick with the lifestyle changes, there’s a chance you will be able to stop the medication in the future.

If you’ve been prescribed a medication after trying diet, exercise, or other lifestyle changes, ask your doctor whether it’s still important to focus on these lifestyle factors. And don’t be surprised if the answer is yes.

Follow me on Twitter @RobShmerling

Related Information: Starting to Exercise

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