New Guidelines May Widen Use of Statins
Recommendations focus on patient risk factors rather than cholesterol numbers, experts say
By Steven Reinberg
TUESDAY, Nov. 12 (HealthDay News) -- New guidelines introduced Tuesday by the nation's leading heart experts could greatly expand the number of Americans taking cholesterol-lowering statins.
The fundamental shift: Doctors are now being told to no longer adhere to rigid clinical guidelines that trigger the use of a statin when cholesterol levels reach a certain threshold.
Instead, people will be advised to take a statin if they already have heart disease, if their bad (LDL) cholesterol is extremely high (190 milligrams per deciliter of blood or more) or if they're middle-aged with type 2 diabetes.
People between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5 percent or more will also be advised to take a statin. Experts say this new rule could greatly alter the number of patients who will now be advised to take such a drug.
In crafting the new guidelines, experts from the American Heart Association and American College of Cardiology spent four years examining the data on heart disease care. The new criteria for who should take a statin also now factors in a person's risk for stroke -- something experts believe may also boost the number of people deemed eligible for the drugs.
"We focused specifically on the use of cholesterol-lowering therapy to determine what works best to reduce the risk of heart attack and stroke," Dr. Neil Stone, a professor of medicine at the Northwestern University Feinberg School of Medicine and chairman of the cholesterol committee, said during a press conference.
The revised cholesterol policy "suggests treatment should be individualized and that, depending on your risk, you may need a higher dose of a more potent statin than if your risk is lower," Dr. Hector Medina, a cardiologist at Scott & White Healthcare in Round Rock, Texas, told HealthDay.
Statins, which include Crestor, Lipitor and Zocor, remain the most effective drugs for reducing cholesterol and should be combined with lifestyle changes for the best results, according to the new report. This approach is better than trying to get cholesterol as low as possible by combining statins with other drugs, the report's authors said.
The committee also said matching patients with the appropriate level of statin therapy is more important than achieving any specific target number, as was common in the past.
For young adults, preventing high cholesterol in the first place can go a long way toward avoiding heart attacks and strokes, the committee added.
About one-third of adults at risk for a heart attack or stroke have not been diagnosed but could benefit from primary prevention -- including taking statins -- according to the report.
Doctors should use known risk factors -- such as age, cholesterol levels, blood pressure, smoking and diabetes -- to assess cardiovascular risk. "These are the strongest predictors of 10-year risk for cardiovascular disease," Dr. Donald Lloyd-Jones, a professor of preventive medicine at the Northwestern University Feinberg School of Medicine and co-chairman of the committee, said during the press conference.