Who Really Needs Statins?

I just read about a new recommendation that everyone age 40 or older take a statin drug to control cholesterol. This seems extreme to me. Do you agree?

– February 16, 2017

Some of the headlines about the recommendation that concerns you were sensational and seemed to suggest that everyone over 40 should be on statin therapy. The reality is much less dramatic. The recommendation came from the U.S. Preventive Services Task Force, a group of independent medical experts commissioned by the government to review the evidence for using statins to prevent heart disease. It was published in November 2016 in the Journal of the American Medical Association (JAMA).

Here’s some background: in 2013 the American Heart Association (AHA) and American College of Cardiology (ACC) made new recommendations for the use of statins based on a 4-year review of evidence on what works best to prevent heart disease and stroke.

Instead of prescribing statins for patients with high LDL (“bad”) cholesterol as had been the case earlier, the new guidelines called for using the drugs to treat two groups of people at increased risk of heart attack or stroke: (1) patients who have diabetes or have had a heart attack and (2) people with very high levels of LDL cholesterol, 190 or above. Beyond that, the guidelines called upon doctors to evaluate other patients on the basis of their risk of having a heart attack or stroke over the next decade as determined by calculations that factor in age, gender, total and HDL (“good”) cholesterol, systolic (top number) blood pressure, blood pressure treatment, diabetes, smoking and the risk of stroke. If that calculation doesn’t lead to a clear-cut decision, the 2013 guidelines suggest taking into account any family history of premature heart disease in a first-degree relative, high-sensitivity C-reactive protein, coronary artery calcium scoring and ankle-brachial index (a test to check the risk of peripheral arterIAL disease).

The new Preventive Services Task Force recommendation suggests that individuals age 40 to 75 with no history of cardiovascular disease take a statin if they have one or more risk factors – high cholesterol, high blood pressure, diabetes or smoking – that pose a 10 percent risk or greater of having a heart attack or stroke in the next 10 years. The Task Force also said that people with a 7.5 to 10 percent risk might also benefit but stopped short of recommending that they take the drugs. The 2013 AHA and ACC guidelines called for treating these people with statins.

Commenting on the Task Force recommendations in a separate JAMA article, Rita F. Redberg, M.D., of the University of California, San Francisco and Mitchell Katz, M.D., of the County of Los Angeles, Department of Health Services, offered this cautionary note: “Current data…(show) that of 100 people who take a statin for 5 years, only 2 of 100 will avoid a [heart attack], and 98 of the 100 will not experience any benefit…. At the same time, 5 to 20 of the 100 will experience muscle aches, weakness, fatigue, cognitive dysfunction, and increased risk of diabetes.”

Be aware that neither the 2013 nor the 2016 statin recommendations are binding on doctors. If you are unsure about your risk factors for cardiovascular disease or whether or not you should be taking a statin, discuss your concerns with your physician.

Andrew Weil, M.D.

Source:

U.S. Preventive Services Task Force, “Final Recommendation Statement: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults.” November 13, 2016, https://www.uspreventiveservicestaskforce.org/Announcements/News/Item/final-recommendation-statement-statin-use-for-the-primary-prevention-of-cardiovascular-disease-in-adults

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