Evaluating the Effect of a Food as Medicine Intervention on Lipid-Lowering Medications

Introduction
Hyperlipidemia is a condition characterized by elevated lipid levels and can lead to serious chronic illnesses that increase morbidity and mortality rates. Patients can take steps to prevent, manage, and treat hyperlipidemia through their diet by increasing fruit and vegetable intake, for example, which has been shown to lower lipid levels and decrease cardiovascular risk. To address the challenge of diet-related chronic diseases, “Food as Medicine” programs have emerged, integrating nutrition into healthcare through produce prescriptions for patients. While there is some evidence to support the benefits of these initiatives, there has been limited research to evaluate their effectiveness, especially on outcomes related to hyperlipidemia or lipid medication utilization.
Methods
This study was an analysis of pre- vs. post-change in prescription medication data for participants (compared to controls) in a quasi-experimental study evaluating the effectiveness of Recipe4Health (R4H), a Food as Medicine intervention. R4H included 12 weekly deliveries of produce, with or without group medical visits (GMV) with 12 weekly sessions. We examined whether R4H was associated with a change in the intensity of participants’ prescribed regimens. Patient prescriptions for statins, any other prescription medications, and relevant supplements were assessed. Regimens were standardized to assess whether a patient’s daily prescribed regimen intensified (e.g. increased dose or added medications), de-intensified (e.g. decreased dose and/or removed medications), or demonstrated no change. Two outcome measures were defined, overall regimen change and statin potency regimen change. Adult participants were included, excluding pregnant women. Generalized linear mixed models were used assuming a multinomial distribution for the outcomes separately for the categories.
Results
The majority of each group, 88% of the control group and FF and 85% of BPFF, maintained their overall lipid medication regimen with no changes (p = 0.15). Similarly, the majority of each group, 88% of control and BPFF and 89% of FF, maintained their statin potency change regimen (p = 0.21). Higher proportions of both intervention groups decreased Statin Potency regimen than the control group (2% in the intervention groups and 1% in the control) and amongst the intervention groups, a slightly higher proportion of BPFF decreased regimen and the control group had the highest proportion of participants that intensified their statin regimen.
Conclusions
A larger R4H evaluation study found significant improvements in lipid outcomes, specifically a decrease in non-HDL cholesterol levels amongst intervention participants. The results of this study show that participants’ medication regimen did not intensify. It is possible that the lifestyle changes as a result of the intervention- an increase in fruit and vegetable consumption- directly led to improvement in lipid outcomes. Notably, there was a trend towards reduction in the statin potency prescription medication regimen (although this was not significant). This could be explained by physicians de-intensifying statin prescription for patients with improved cholesterol levels.