According to The American Heart Association and The American College of Cardiology, 33 million Americans should now be on statin-type cholesterol-lowering drugs. That means about twice as many people as are currently prescribed these drugs. Using the new guidelines, physicians should be prescribing a statin to roughly 44 percent of men and 22 percent of women. Are you one of them?
Here’s what the heart experts are recommending:
1) Any adult who has already been diagnosed with heart disease should be on an aggressive statin regimen.
2) Anyone who has an LDL cholesterol over 190 should also be on “high-intensity” statin therapy.
3) Anyone between the ages of 40 and 75 who has diabetes should be on moderate-intensity statin treatment.
4) Anyone who scores more than a 7.5% risk of a heart attack or stroke over the next decade is supposed to be on moderate-to-high intensity statin medication dose.
How do you determine if your 10-year risk of a cardiovascular event reaches the magic 7.5% or higher? The committee that drew up the guidelines created a risk calculator that takes into account sex, age, race, total cholesterol, HDL cholesterol, systolic blood pressure, diabetes, smoking history, and whether you are on treatment for hypertension.
So here’s a test for you. Would a 58-year-old non-smoking white man with a total cholesterol of 200, good HDL cholesterol of 45, systolic blood pressure of 125 and not diabetic require a statin under the new guidelines? Answer: YES! That’s even if he has no evidence of heart disease.
Were the same man to be 55, he would not trigger a statin prescription. Do three years make that much difference? According to the guideline committee, you bet!
Even though there is relatively little good data to support the use of statins in older people, the risk calculator mandates a prescription for senior citizens with seemingly good numbers. Here’s another hypothetical patient:
A non-smoking, non-diabetic 70-year-old African American woman with fabulous numbers: total cholesterol 175, good HDL 90 and a systolic blood pressure of 115 still requires a statin according to the risk calculator.
This wouldn’t trouble us nearly so much if statins were benign drugs with a low likelihood of causing side effects. In recent years we have learned that statins not only cause many people substantial muscle pain and weakness, but they can also cause fatigue, joint pain, digestive upset, headache, cataracts, dizziness, sexual problems, peripheral neuropathy and cognitive dysfunction. To learn more about the dangers of statins and other ways to manage risk factors, we offer Graedons’ Guide to Cholesterol Control & Heart Health.
We were especially alarmed to note that everyone with a diagnosis of diabetes between 40 and 75 years of age will be prescribed a statin under the new guidelines. The problem is that statins can actually trigger diabetes in susceptible people and can make blood sugar control more challenging for some patients. This complication seems to have been ignored by the guideline committee.
So, what are we to make of the new guidelines? Not following the guidelines can get a physician into trouble, so doctors will doubtless feel pressured to write more prescriptions for drugs like atorvastatin, lovastatin and simvastatin. Manufacturers of brand name statins still under patent (Altoprev, Crestor, Livalo) may celebrate and consider more advertising.
We think that before millions more people start taking statins, they should consider whether diet and exercise could accomplish the same goals of preventing heart attacks and strokes. A recent essay in JAMA Internal Medicine (Oct. 28, 2013) pointed out that adhering to a Mediterranean diet can lower post-heart attack risk by 30%: “this is as powerful as the effect of statins, without the adverse effects or costs.”
What do you think of the new guidelines? Share your experience with statins? Would you ask your doctor for a statin prescription if the risk calculator says you are over the 7.5% cutoff? Please add your thoughts below in the comment section. Others will be interested in your opinion.