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Making Sense Of The New Statin Recommendations

 

New guidelines issued for statin prescriptions: image via sciencedaily.comNew guidelines issued for statin prescriptions: image via sciencedaily.comPerhaps you've read that the American College of Cardiology (ACC) and the American Heart Association (AHA) issued new guidelines on which persons should take statin drugs for the prevention of heart disease and stroke. On March 19, 2014, in the New England Journal of Medicine, the AHA presented these guidelines, including age, gender, and race, as well as various pre-existing health conditions that might call for statin intervention. But what do the new guidelines mean for you?

Statin drugs like Lipitor®, Crestor©, Zocor®, and other brand and generic name drugs, help lower cholesterol levels, particularly low-density lipoproteins (LDL), or "bad" cholesterol.  As high levels of LDL are complicit in cardiovascular diseases, primarily heart disease and stroke, statins perform a preventative function.

Statins also have other biochemical effects that lower risk for cardiovascular disease, and they have been shown to lower risk of Alzheimer's disease, decrease risk of death from prostate cancer, and positively impact other disease processes not directly related to heart disease and stroke. But the panel of cardiologists making the new recommendations were concerned only with statin use to prevent atherosclerotic cardiovascular disease (ASCVD) - defined as a "coronary death or nonfatal myocardial infarction, or fatal or non-fatal stroke." 

Prior guidelines for statin prescription, issued in 2002, encouraged doctors to prescribe statin drugs based on cholesterol numbers, particularly LDL numbers. If your LDL was 160 or over, you were prescribed statins.  The new guidelines, however, call for doctors to look at the complete profile of each patient - age, gender, race, and any specific health conditions which might increase a patient's risk of an ASCVD event within 10 years.

 

ASCVD Risk Assessment Chart: image via americanheart.orgASCVD Risk Assessment Chart: image via americanheart.org

 

As implied, the new guidelines recognize that there can be many factors contributing to ASCVD - not only high LDL cholesterol.  High blood pressure, for example, diabetes, obesity, smoking history, a family history of or a patient's previous heart attack or stroke are some of the indicators that statins should be considered. Age, race, and gender may be risk factors, the study indicating, for example, that black women over 60 might be more at risk for ASCVD than white women over the age of 60. High cholesterol should definitely be a factor in prescribing statins, but not the only factor.

In general, the new statin guidelines recommend that physicians prescribe statins to:

  • People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years.

  • People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).

  • People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).

  • People with Type 1 or Type 2 diabetes who are 40 to 75 years old.

It should be stressed that the above recommendations are general ones. You should discuss your individual health history with your physician so the appropriate recommendations can be made for you.

 

sources: New England Journal of Medicine, CirculationAmerican Heart AssociationBlog.Heart.Org., WebMD

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