What Do You Think About New Statin Guidelines?

In case you missed the hype, earlier this month the American Heart Association and the American College of Cardiology released new cholesterol treatment guidelines.  Under these new recommendations nearly 72 million Americans would be eligible for statin therapy.  This seems pretty steep.  New statin guidelines are so drastic that physicians, nurse practitioners and patients alike are calling their credibility into question.  What do you think about the new statin guidelines?  Are they appropriately stringent or unnecessarily placing millions of Americans on prescription medications?

Which patients are treated under new statin therapy guidelines?

New statin guidelines released by the American Heart Association, focus not on specifically lowering LDL to a target level as in previous guidelines but rather on identifying patients for whom lowering LDL is shown to be most beneficial.  The numerical values for optimal LDL cholesterol level have not changed.  New guidelines recommend four groups of patients receive statin medication to lower cholesterol levels:

  • Patients who have cardiovascular disease
  • Patients with an LDL of 190 mg/dL or higher
  • Patients with Type 2 diabetes who are between 40 and 75 years of age
  • Patients with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years of age.  A 10-year risk calculator is available from the American Heart Association online. 

Recognizing that cardiovascular disease is currently the leading cause of disability and death in the United States, a panel of experts from the American Heart Association analyzed data from prior studies to develop these new cholesterol treatment guidelines. Statins were selected as the therapy of choice given their efficacy and safety profile.

Medical professionals aren't disagreeing on the fact that most Americans could be more heart healthy, however some are taking issue with the American Heart Association's new recommendations.  Many providers question if tens of millions Americans really need to take these medications.  After all, they are not without side effects.  Others suspect  pharmaceutical companies or other parties with financial incentives may have involved in creating these new statin recommendations tainting their credibility. 

Why did cholesterol treatment guidelines change?

Prior cholesterol treatment guidelines, recommending a total cholesterol level of less than 200 mg/dL and an LDL of less than 100mg/dL for most patients, were based on the Framingham Heart Study, a long-term trial on heart disease beginning in 1948.  Most participants in this study were white males.  Cholesterol treatment recommendations were extrapolated from these studies and applied to healthy populations of all ethnicities with the goal of helping them prevent cardiovascular disease, heart attacks and strokes.  Researchers wanted to create new guidelines that were more applicable to all populations.  To create new guidelines, a panel of experts reviewed prior studies on heart disease including groups such as African-Americans known to have higher incidence of heart disease.  This project resulted in controversial further reaching cholesterol treatment guidelines. 

Medical providers take issue with statin treatment recommendations

Some studies show statins may not actually be very effective in preventing heart disease.  The only demographic shown to benefit from statin use is men who have experienced a previous heart attack.  For other groups, the data is conflicting or indicates that statins confer no benefit.  Given these studies, new recommendations may place millions of Americans on medications that may have no effect on their health.

Statin medications carry significant risks and should not be prescribed lightly, certainly not to 72 million Americans.  About 20 percent of statin users experience intolerable side effects like muscle aches and depression.  Statins may make users more likely to develop other chronic health problems like type 2 diabetes and memory loss.  A recent study indicates statin usage increases risk of cataracts by 27%. Rare but potentially serious side effects like rhabdomyolysis and liver failure are also well documented.

While it is undoubtedly important to keep cholesterol levels at a healthy low, prescribing medications to 72 million Americans is taking the lazy way out.  We must prioritize encouraging patients to consume a healthy diet and to exercise.  This should be presented as the only perfectly healthy way of preventing cardiovascular disease.  Yes, many patients won't listen, won't make lifestyle changes or may be too far down the road of poor heart health to implement some of these recommendations.  Regardless, we must warn our patients there isn't a magic pill for treating cholesterol. Like most things in life, the slow, difficult route of diet and exercise is the best, the most rewarding and most effective way to reduce cholesterol levels.

As healthcare providers we see a lot of grey lines.  Guidelines and research are constantly changing.  Studies frequently contradict each other.  The one thing that hasn't changed over the years is that healthy living prevents and even cures without side effects.  Yes, there is a place for medications but we shouldn't blindly follow recommendations.  We must review them critically.  Even as we become more pressed for quality time with our patients we must take the responsibility to encourage healthy lifestyles using medications as a secondary treatment option.  We must take the time to collaborate with our patients together weighing the risks and benefits of pharmacological and lifestyle therapies to decide on the best option for each individual. 

What do you think of new statin guidelines?  Are these recommendations appropriate or are they placing millions of Americans on medications unnecessarily?

 

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