New guidelines are still controversial for older adults who don’t appear to have heart disease.
The debate is still raging over last November’s guidelines that changed who should take statins, the drugs that help lower cholesterol. For seemingly healthy adults, the guidelines take the focus off LDL or “bad” cholesterol as a marker for statin use, and place the focus on a person’s risk factors for developing heart disease or stroke—such as older age, high blood pressure, diabetes, smoking, other family members with heart disease, tests that show calcium in the heart’s arteries, or blood levels of C-reactive protein (CRP). “That’s a huge change,” says cardiologist Dr. Christopher Cannon, a Harvard Medical School professor.
How it works
The new guidelines came from the American Heart Association and the American College of Cardiology. They were prompted by research, much of it from Harvard Medical School, that has reported additional heart benefits from statins besides lowering LDL cholesterol levels in the blood.
For healthy adults ages 40 to 75, doctors are now asked to determine risk using an equation that takes into account the person’s age, gender, race, total cholesterol, blood pressure, diabetes, and smoking history. Statins are advised for people with a 7.5% risk for heart attack or stroke in the next 10 years. “Just one problem,” says Dr. Cannon. “Once you hit age 64, everyone meets the criteria based on age, not cholesterol. And it’s not known if an otherwise healthy older adult with normal cholesterol would avoid heart attack with a statin, because no trial has studied that.”
Who gets a statin?
Some doctors worry that the threshold for statin use is too low. A study published March 19, 2014, in The New England Journal of Medicine estimates that almost 13 million people will now be eligible for statins, most of them older adults without cardiovascular disease. But Dr. Cannon says that, for him, a 7.5% risk is not automatic grounds for a prescription. “Personally I will still look at that risk and add high cholesterol. So if the LDL is above 100, that’s high, and a statin has been shown to help,” explains Dr. Cannon.
Dr. Cannon stresses that the new risk calculator applies only to seemingly healthy adults. Statins are still recommended and prescribed routinely for all people with known heart disease, for people with very high LDL cholesterol (190 mg/dL or higher), and for middle-aged adults with type 2 diabetes.
Know your statins
There are seven different statins approved in the United States: atorvastatin (generic, Lipitor), fluvastatin (generic, Lescol), lovastatin (generic, Mevacor), pitavastatin (Livalo), pravastatin (generic, Pravachol), rosuvastatin (Crestor), and simvastatin (generic, Zocor). All of them lower LDL cholesterol and thereby reduce the risk you will develop artery-clogging plaque. Statins may cause muscle pain and raise blood sugar.
What you should do
At your next doctor visit, ask if the new guidelines apply to you and if statins would have a meaningful impact on your risk for heart disease and stroke. You should also ask what you need to do to reduce your risk. A good start: eat a diet low in salt and saturated fat and high in fruits, vegetables, and whole grains, and get 150 minutes each week of moderate-intensity exercise, such as brisk walking or swimming.