You are here:

New guidelines could make it easier for you to keep your heart healthy

The science leans toward more aggressive use of statin drugs to prevent heart problems, but medication is not a “must do.”

Doctors have a new roadmap for preventing heart attacks, strokes, and other harmful outcomes of cardiovascular disease. The guidelines, released by experts with the American Heart Association and American College of Cardiology in November 2013, are the first update in more than a decade. “The guidelines provide a simplified approach to reducing cardiovascular risk,” says Dr. Joanne Foody, an expert in preventive cardiology at Harvard-affiliated Brigham and Women’s Hospital.

The guidelines have reignited the debate over how many Americans should take cholesterol-lowering statin drugs. But they are just a roadmap of options, not a push-button list of must-do’s. You don’t need to take a statin unless you and your doctor agree that its benefits are worth the costs.

Lowering the bar for statins

Under the previous guidelines, you would consider a statin if your LDL level was high or if your chance of having a heart attack or other cardiovascular problem passed a certain threshold—typically at least a 10% chance over the next 10 years.

The new guidelines focus more on risk, and now recommend starting a statin if your risk is 7.5% or higher, regardless of LDL level. “That conversation could now happen sooner for more people,” says Dr. William Kormos, Editor in Chief of Harvard Men’s Health Watch. Some experts have questioned the method that the new guidelines use to estimate 10-year risk, but the bar has definitely been lowered.

Statin therapy has also been streamlined. Instead of adjusting the dose to reduce LDL cholesterol to a set goal, you work up to a certain “intensity” of statin therapy, based on the type of statin and the amount you take:

  • Moderate-intensity therapy, which lowers LDL by 30% to 50%.

  • High-intensity therapy, which lowers LDL by 50% or more.

The guidelines help your doctor to match the intensity of statin therapy to your cardiac risk. The higher your risk, the more intense the cholesterol-lowering will be.

Using set doses makes it less necessary to do regular follow-up lab tests to “check your numbers,” even though many physicians may continue to do the tests to measure the effect of the medications on LDL.

Heart health guidelines: What’s new?

  • A larger number of people may meet criteria for statin therapy.

  • Your overall risk of heart disease is now a more important trigger for starting a statin than your baseline cholesterol level.

  • Once you are on the right dose of statin, you may need cholesterol checks less frequently.

  • There is no proven benefit from adding fibrates, niacin, or fish oil to statin therapy.

Image: Thinkstock

What does it mean for you?

If you are already taking a statin, you probably will continue to do so, but the type or dose of statin could change. The previous guidelines gave some people too high a dose and others too low a dose. The new guidelines attempt to correct that.

If you do not presently take a statin, the decision depends on your individual risk factors. Assessing your individual risk can be a complicated affair; let your doctor help you do it. If you start on a statin, you need to take it daily for the long haul to benefit from it. Whatever your risk is now, the statin can lower it by 30% to 50% or more.

But be aware that not every man who sticks faithfully to his statin regimen will avoid a heart attack, stroke, or death related to heart disease.

For example, suppose 100 men with a 10-year cardiac risk of 10% get high-intensity statin therapy. This is expected to cut the risk in half.

But in the end, that prevents bad things from happening to only five individuals. Another five will still have a bad outcome, and 90 of the group would not have had a problem regardless of taking a statin.

Of course, what you are betting on is that you will be among those lucky five men. It could save your life, but that is not guaranteed.

Side effects are possible, too, but they are usually not severe and can often be reversed by adjusting the statin or dose. The most common ones are muscle aches and pains or a rise in blood sugar that could tip you into a diagnosis of diabetes. The overall chance of benefit is lower than the risk of harm, so many physicians think it’s a good wager.

“Consider the statin if you really want to do everything you can to lower your cardiac risk—because that’s important to you—and if you don’t mind taking a pill every day and accept you might get a muscle ache,” Dr. Kormos says. “But if you don’t want to, it’s not a dramatic difference in risk for men in the lower risk group.”

And don’t stop there. A healthy lifestyle is still the foundation of a healthy heart and provides many other benefits. Still, you need not forgo the extra help from a statin in hopes of doing it all with diet and exercise. The best research we have right now says statins help and the downsides are usually moderate and manageable.

Posted by: Dr.Health

Back to Top