New Guidelines for Statins

By:    Medically Reviewed: Tom Iarocci, MD   Published: February 21, 2014

Treating high cholesterol and lowering heart disease risks often demand more than simple diet changes and consistent exercise.

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For both men and women, heart disease is the leading cause of death in the U.S., claiming more than 600,000 lives every year. While no one is arguing about the importance of preventing as many of these deaths as possible, there is debate about how to best approach prevention, particularly when it comes to the use of cholesterol-lowering drugs called statins.

The American Heart Association (AHA) and the American College of Cardiology (ACC) recently issued new guidelines on the use of statins, such as Lipitor and Zocor. The guidelines, which are being criticized by some in the medical community, call for doctors to use a broader method when determining who should take statins.

 

What is the controversy over statins?

Traditionally, doctors have used a patient’s LDL (bad) cholesterol level to determine whether or not to prescribe statins; the new guidelines recommend doctors look at the patient’s overall risk of developing heart disease using a cholesterol risk calculator instead of relying solely on his cholesterol levels. Statins have usually been prescribed to reduce the risk of heart attacks, but the new guidelines recommend statins also be used for stroke prevention.

 

Called “The Pooled Cohort Risk Estimator,” the cholesterol risk calculator works by using patient characteristics — such as age, gender, race, blood pressure, diabetes and smoking — to calculate a person’s 10-year risk of heart attack or stroke.

 

Some critics have called the calculator flawed, saying it overstates people’s risk of heart disease and could result in doctors prescribing statins to many who don’t truly need them. But the AHA and ACC stand by the risk calculator.

 

“The controversy stems primarily from physicians who have tried to apply the estimator to lower risk populations and found, not unexpectedly, that the estimated risk was too high for their populations,” explains cardiologist Kim Allan Williams Sr., MD, vice president of the ACC.

 

And while the recommended guidelines have sparked disputation, they have also fortunately raised awareness of this critical health issue.

 

“An encouraging aspect of this [statin] debate is that more people will now ask their doctors about their heart disease risk and what steps they should be taking,” says Williams. “They will also discuss factors such as family history, diabetes or smoking cessation, too.”

 

Who should take statins?

If your doctor determines you are already at moderate or high risk of heart attack or stroke, statin medications should be considered. Current guidelines now recommend statin therapy for individuals with the following:

 

  • “Bad” LDL cholesterol levels of 190 mg/dL or higher,
  • Type 2 diabetes who are between the ages of 40 and 75,
  • An estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between the ages of 40 and 75, or
  • Existing cardiovascular disease.

 

Take the next steps

The issuance of the new statin guidelines serves as an opportunity to have a conversation with your health care provider about your heart disease risk, whether you’re currently being treated for high cholesterol or not. Don’t put it off; talk to your doctor.

 

Your health care provider can use the new calculator to estimate and provide information about your chances of having a heart attack or stroke in the next decade. Here’s what else helps lower your risk:

 

  • For everyone, lifestyle changes have a powerful effect on overall heart health. The AHA recommends regular exercise, quitting smoking and maintaining a healthy weight.
  • For both patients and caregivers, sustaining a heart-healthy diet — low in sodium and saturated fats — is key. Your meal plan should include daily whole grains, a couple of servings of fish per week and several servings of fruits and vegetables.
  • If lifestyle tweaks are unsuccessful in lowering your LDL cholesterol levels and alleviating other risk factors, the new guidelines recommend taking statins to lower your LDL levels and prevent heart disease. 
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sources
  • Williams KA, Sr., MD, FACC, vice president of the American College of Cardiology. http://www.cardiosource.org. Interviewed November 2013.
  • Centers for Disease Control and Prevention. “Heart Disease Facts.” http://www.cdc.gov/heartdisease/facts.htm. Accessed November 2013.
  • American College of Cardiology. “ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.” Circulation, November 12, 2013. http://circ.ahajournals.org. Accessed November 2013.
  • American Heart Association, “Healthy Diet Goals.” http://www.heart.org. Accessed November 2013.
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