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New studies support statin guidelines

Discuss your own situation and preferences with your doctor when deciding whether to take a statin.

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But if you are healthy, deciding if these commonly prescribed drugs are right for you is a personal choice.

For many years, the main deciding factor for taking a statin was how much harmful low-density lipoprotein (LDL) cholesterol was circulating though your bloodstream. That all changed about two years ago, when leading cardiology organizations issued new guidelines that shifted away from targeting LDL. The biggest change was for people ages 40 to 75 who have a 7.5% or higher risk of having a heart attack or stroke over the next 10 years (see “What’s your risk?”).

Yet some doctors challenged the recommendations, arguing that many healthy adults would end up taking a statin but get little benefit from the drug while running the risk of developing side effects such as muscle pain and diabetes. Now, two new studies suggest that the new guidelines appear to be more accurate and cost-effective than the old ones.

“We’re moving the dial toward a more accurate prediction of heart disease risk and its relevance to statin therapy,” says Dr. Christopher O’Donnell, associate professor at Harvard Medical School and co-author of one of the studies, both published July 14 in the Journal of the American Medical Association (JAMA).

Clarifying the benefits

One of the studies included 2,435 people from the long-running Framingham Heart study who were not taking a statin. Researchers determined that 39% of these people would have been eligible to take a statin under the new guidelines, versus 14% under the older guidelines. They then looked at the numbers of heart attacks, strokes, and deaths from cardiovascular disease in both groups over a nearly 10-year period. The rates in both groups were nearly the same (just over 6%), suggesting that the new guidelines wouldn’t put too many people on the drugs unnecessarily. And when they looked at the people who weren’t eligible for a statin under the new guidelines, just 1% had a heart attack or stroke. Under the old ones, 2.4% did. That suggests that the new guidelines provide a more accurate assessment of who would benefit from a statin and who wouldn’t.

What’s your risk?

To estimate your odds of having a heart attack or stroke over the next decade, see www.health.harvard.edu/heartrisk. You’ll need to know your total and HDL cholesterol values and blood pressure reading.

The other JAMA study relied on a computer model that projected the costs for a hypothetical group of Americans ages 40 to 75 who would take a statin based on the new guidelines. These costs include the expense of cholesterol testing, medications, and lab and doctor visits, as well as the cost of treating heart attacks and strokes, says senior author Dr. Thomas A. Gaziano, cardiologist at Brigham and Women’s Hospital. The downsides of taking a statin, including the inconvenience of taking a daily pill and a slightly higher risk of diabetes related to statin use, were also part of the equation.

Another key factor in the model was a measure known as the quality-adjusted life-year, which measures the burden of a disease in terms of both the quality and quantity of life lived. The model showed that the new guidelines—which would put almost half of adults ages 40 to 75 on a statin—would be cost-effective, at least based on the overall expense to society as a whole.

Should you take a statin?

If all this has you wondering if you should be taking a statin, here’s another way to think about the decision. Statins lower the risk of a heart attack by about 20%. “If you’re in a low-risk group, say 5%, taking a statin reduces your risk to 4%,” ex-plains Dr. Gaziano. Some people in that group might decide it’s not worth the hassle of taking a drug every day for a very small benefit. But others might want to do everything they possibly can to lower their risk, he says. That’s why it’s so important to have a discussion with your doctor about your own situation and preferences.

But don’t neglect the other important ways to lower your risk of heart disease. Healthy lifestyle habits like avoiding tobacco, getting regular exercise, and eating a good diet can help your heart as well as your overall health.

The other statin guidelines

In addition to recommending statins for people with a 7.5% or higher risk of cardiovascular disease in the next 10 years, the new guidelines also recommend statins for people in these risk categories:

  • anyone who has cardiovascular disease, including angina (chest pain with exercise or stress), a previous heart attack or stroke, or related conditions

  • anyone with a very high level LDL (generally 190 mg/dL or above)

  • anyone with diabetes who is 40 to

Posted by: Dr.Health

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