Actually, it goes without saying: medicines can only work if they are used correctly.
However, adherence to therapy, known in technical jargon as adherence, often leaves a lot to be desired.
It tends to be particularly inadequate when the health benefits of the drugs do not become apparent immediately, but only in the medium to long term.
For example, high blood pressure and elevated cholesterol levels do not cause immediate distress, but in the long run lead to atherosclerotic vascular damage and its consequences, including heart attacks and strokes.
This risk can be reduced on the one hand by changing one's lifestyle, especially with regard to diet, and on the other hand with medication that relieves the heart and prevents vascular occlusion.
The more pronounced the atherosclerotic vascular damage is and the greater the risk of a heart attack, the more those affected benefit from such treatment.
Even with severely affected people, there are still a number of people whose adherence to therapy is not the best.
This even applies to the participants in scientific studies - i.e. to patients who are usually cared for particularly closely.
What has already been observed more frequently is now also the result of an international study.
who are usually looked after particularly closely.
What has already been observed more frequently is now also the result of an international study.
who are usually looked after particularly closely.
What has already been observed more frequently is now also the result of an international study.
Almost 4,500 men and women with circulatory disorders in the heart muscle caused by atherosclerosis took part in the "Ischemia" experiment.
Many patients already suffered from chest tightness under stress, angina pectoris.
This occurs when the heart muscle noticeably "gasps for air" during increased exertion because its vessels are already narrowed by atherosclerosis.
As far as therapy is concerned, all of the test participants had been provided with the usual medications to protect against heart attacks and to relieve angina pectoris.
This list includes cholesterol-lowering drugs, antithrombotic drugs, and high blood pressure drugs, as needed.
In one half of the subjects, selected at random, the study doctors had also performed cardiovascular treatment, coronary revascularization.
They either expanded the narrowed coronary arteries with a catheter or bypassed them with a vessel removed from another source (bypass operation).
A previous analysis of the study data from "Ischemia" had shown that patients with chest tightness benefit from coronary revascularization.
The mortality and heart attack risk of those affected did not decrease, but the frequency and severity of their angina pectoris attacks did.
The current study addressed the question of whether coronary revascularization can cushion inadequate adherence to therapy.
What use are medicines that are not taken?
As the study authors around Angel Garcia and John Spertus from the Mid America Heart Institute in Kansas City/Missouri write in the "Journal of the American College of Cardiology", almost 30 percent of the patients in both treatment groups did not use the prescribed medication regularly.
Further analysis revealed that these subjects were consistently less resilient and experienced more angina symptoms than those who had followed treatment regimens;
the chest tightness of the patients with poor adherence to therapy also decreased comparatively less over the course of a year.
Contrary to what the study authors suspected, coronary revascularization was not able to reduce the health deficit of this group.
So it was not possible to compensate for the unfavorable consequences of irregular tablet intake.
In an accompanying editorial, the cardiologist Usman Baber from the University of Oklahoma in Oklahoma City and other doctors point out that the success of drug therapy depends not only on the cooperation of the patients, but also on the actions of the doctors.
As they also criticize, there is a tendency in cardiology to reach for the catheter too early.
Studies in America have shown that only a third of all patients who undergo non-emergency dilatation of constricted heart vessels have previously received sufficient medication.
As Hans-Reiner Figulla, emeritus cardiologist at the University Hospital in Jena, explains when asked, the situation in Germany is comparable.
If the doctor discovers a bottleneck when examining the coronary arteries with a catheter, there is a great temptation to expand the narrowed vessel and fit a stent in the same session, explains Figulla.
He adds that patients are mostly ok with this.
Because it is easy to convey to them that a narrowed blood vessel in the heart could pose a danger and should therefore be treated.
However, as several scientific studies have shown, catheter therapies are only useful under two circumstances.
For example, they can often immediately improve severe chest tightness and sustainably reduce the mortality rate of patients with acute heart attacks.