Ask an Expert: When Should Prescription Drugs Be Considered to Help Prevent Heart Disease?

Verywell Health: When should prescription drug intervention be considered to help prevent heart disease?

Dr. Velarde: When honest efforts to incorporate lifestyle changes have not yielded the expected results, medication can and should be considered.

This starts by setting specific targets for specific risk markers (say, blood pressure measurement) and making the basic lifestyle interventions for them. If, after three to six months of lifestyle changes, you have not met your target or goal, then it’s time to intervene with medication.

However, it is critical that patients know that there’s no finite period for lifestyle changes. They shouldn’t be abandoned because you are starting medication. Lifestyle changes should be made for life, irrespective of the patient being on medication or not.

Unfortunately, this message isn’t always heard by patients. They may think that once they’re on medication, they can free up their eating choices or commitment to movement. That isn’t the case. The point is to give lifestyle changes an honest effort first and then if targets have not been met, start a prescribed medication regimen.

This is especially the case for blood pressure. For example, we know that nearly half of the U.S. adult population (47%, or 116 million) suffers from high blood pressure and that about two-thirds of those need more than two medications to control it. So what’s the point of taking one or two medications if there is no sound lifestyle foundation first? Oftentimes, patients don’t do what is required—the basic lifestyle effort—for blood pressure to be controlled with medications.

In many cases, the baseline lifestyle commitments don’t take hold or are abandoned. The reasons for this are complex but constitute barriers we need to identify and overcome. Compliance with medications also often involve cost, access to care, and lack of awareness of the repercussions of risk factors if left untreated. But not achieving the baseline lifestyle changes necessary is an extremely important first step.