Recent media reports have caused some alarm and confusion about newly published guidelines for statin drugs. Statin drugs reduce cholesterol levels and also decrease cardiac and vascular disease, independent of their cholesterol-lowering effect. Statins provide multiple benefits, but the mechanisms of their actions are not yet fully understood. Like any medication, there is a risk of side effects, which can occur in up to 18 percent of patients and most often consist of muscle pain or temporary derangement of liver function. Rare serious side effects have been described.
Previous Guidelines Based on LDL Levels
Previous guidelines for statin use were issued by the National Heart, Lung, and Blood Institute in 2001. Evidence to support specific recommendations was sometimes not conclusive, as described in the 275-page document; despite this, the guidelines focused on reducing low-density lipoproteins (LDL, sometimes called “bad” cholesterol) below a specific level. This recommendation was a bonanza for the statin manufacturers, as the number of Americans for whom cholesterol-lowering drugs were recommended jumped from 13 million to 36 million!
New Guidelines Focus on Risk Assessment
The new (2013) recommendations, from the American College of Cardiology and American Heart Association joint task force, reviewed newer scientific evidence and suggest a completely different approach from that of 2001: the broad goal now is to reduce the risk of stroke or heart attack. According to the World Health Organization, 80% of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet and other lifestyle factors. Just like a healthy diet and moderate exercise, statins do reduce the risks of stroke or heart attack as shown in clinical trials, but this evidence does not support a specific target level of LDL.
The new guidelines define patients who are at high risk of stroke or heart attack as those with diabetes or previous heart attack, or bypass surgery. Guidelines now recommend that all of these high-risk patients take a statin forever (unless a patient has a specific contraindication) regardless of their LDL level. All other patients over the age of 40 years (who do not fit in the high risk category) should now be assessed using a new risk calculator, which considers blood pressure, age, smoking and diabetes, as well as lipid levels in the blood, and estimates how likely each patient is to develop cardiac or vascular disease. Based on the projected risk, treatment with statins will be suggested, aiming to slow the progression of disease.
Statins: Just One Part of Improving Cardiovascular Health
Statins are not a “quick fix” and must not be used in place of treating those factors which we know decrease heart and vascular disease (by smoking cessation, diet modification, moderate exercise and control of diabetes.) Patients should discuss statins with their doctors. If statin treatment is advised, please take the medicine but remember that statin use is only one part of what must be a comprehensive effort to achieve cardiovascular health.
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