Government panel: more people should be on statins
Statins, drugs used to lower cholesterol, are one of the most widely prescribed medications in the United States. Now, new guidelines by an expert panel will expand the number of people who are on them even further.
Are statins right for you?
If you’re 40 to 75 and you smoke or have high cholesterol, high blood pressure or diabetes, you should be on statins, according to the U.S. Preventive Services Task Force. The task force, a panel of national experts in prevention and evidence-based medicine, published its recommendations in the Journal of the American Medical Association.
“Medicare follows the task force’s guidelines,” said Peter Chiotellis, MD, a cardiologist based at the Heart Center in Hyannis. “What it means is that there will be a lot more people on statin medications.”
The task force guidelines are similar to ones established by the American College of Cardiology (ACA) and the American Heart Association (AHA) in 2013 except that the task force says people with a 10 percent or greater risk of having a heart attack or stroke in the next 10 years should be on statins (the ACA/AHA guidelines said that people with a 7.5 percent or greater risk should be on statins).
Additionally, the task force said everyone over 40 should be screened to see if they need statins, whether or not they have a history of cardiovascular disease.
“People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke,” Kirsten Bibbins-Domingo, the task force’s chair, told the Washington Post.
“Statins have been proven to lower people’s risk of heart disease and heart attacks, primarily through lowering your cholesterol,” said Dr. Chiotellis. “I think a lot of people are under-treated for their risk factors.
“Your 10-year cardiovascular risk score takes into account age, smoking history, blood pressure and total cholesterol. If you’re 7.5 percent or greater, then you should be talking to your physician or cardiologist about being prescribed a statin medication.”
He said some patients are surprised that the guidelines suggest that they should be on statins.
“If you tell someone they have a 10 percent risk of a heart attack over 10 years, in their mind they have a 90 percent chance of not having a heart attack,” he said.
“Usually with my patients, unless they’re really high risk, I use the new guidelines but I also give them a chance to make some lifestyle changes before prescribing statins. They might come back and say, ‘I tried. I can’t get my risk score down. I can’t get my cholesterol down.’ Then they’re more likely to accept being on statins.”
More than 25 million people in the U.S. are on statins, according to Dr. Chiotellis. Lipitor and Crestor, brand names for two types of statin, were widely prescribed, but low-cost generic versions are now available.
A University of Oxford study reported last fall in The Lancet found that statins cut the risk of heart attack and stroke by 10 percent for people who have already had a heart event and 5 percent for people who have not had a heart event but have a high risk factor.
“The main reason for people stopping is if they develop side effects, like muscle aches,” he said. “Sometimes, if people make dramatic lifestyle changes and they get their weight down, I have no problem taking people off statins.
“There are other people who have had previous heart attacks and heart disease and strokes who will be on statins life-long because of the way their body processes cholesterol. They’ve already shown themselves as high risk.
“Statins are probably one of the most researched medications. They save lives and that’s the important thing to remember.”