(RxWiki News) When it comes to deciding which patients should take statins to keep their hearts healthy, the focus may be shifting. Recent guidelines on statin use focused less on cholesterol levels and more on other factors, such as age or a history of diabetes.
The guidelines suggest that all men and most women in their late 60s and early 70s may need the cholesterol-lowering medications to maintain their heart health.
Who should take statins remains a debated issue due to factors like potential side effects. The authors of the recent study on the new guidelines for statin use said more research on the topic is needed.
Jeffrey M. Schussler, MD, FACC, FSCAI, FSCCT, a cardiologist at Baylor University Medical Center in Dallas, TX, said he prescribes statins whenever appropriate.
"The new guidelines lower the threshold for use of statins in a much wider population," he told dailyRx News. "In general, since so many of us (50% or more) are going to die of a cardiovascular event, it makes sense to use the most effective treatment with the fewest side effects. Very few people have side effects when using statins, and dangerous side effects are exceptionally rare. They are cheap, with generics as low as $4. They are effective, showing reduction in cardiovascular events. With such a high potential benefit, and such a small downside, it makes sense to encourage the use of these medications wherever applicable."
Michael D. Miedema, MD, of the Minneapolis Heart Institute Foundation in Minnesota, and colleagues wrote the recent research on the new statin guidelines.
"The guidelines are a significant change from prior guidelines that relied heavily on levels of bad cholesterol to determine who to treat," Dr. Miedema said in a press release. "Instead, the new guidelines recommend focusing statin therapy on the individuals that are at the highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits."
The new guidelines — released in 2013 by the American College of Cardiology and American Heart Association — use a risk calculator to figure out who is at risk for a heart attack or stroke in the next 10 years. Those with known heart disease, diabetes or high cholesterol are high-risk, but the calculator also takes age and gender into account. Anyone who has a 7.5 percent or higher risk for heart disease on the risk calculator should consider taking statins, the guidelines suggest.
Dr. Miedema and team studied who would need to be prescribed statins under the old guidelines and under the new ones. They looked at 6,088 adults aged 66 to 90 who were in the Atherosclerosis Risk in Communities (ARIC) study.
According to the old 2003 guidelines, issued by the National Heart, Lung and Blood Institute, 72.8 percent of the ARIC group should receive statins. These guidelines focused less on medical history and age and more on prescribing statins for people with high levels of low-density lipoprotein (LDL) cholesterol. LDL is considered "bad" cholesterol because it can collect on the walls of arteries, making it difficult for blood to pass through — a sign of heart disease.
However, 97 percent of the ARIC group would be advised to take statins under the 2013 guidelines. Furthermore, 100 percent of men between the ages of 66 and 75 would be told to take statins under the new guidelines, Dr. Miedema and team noted.
Dr. Miedema pointed out that the guidelines don't provide recommendations for patients older than 75.
"We don't have great data on the efficacy of statin medications in the elderly so the guidelines drew a cut-off for the recommendations at age 75," he said in a press release. "This is understandable, but it kind of leaves clinicians in the dark as to what to do with healthy elderly patients, who are often at high risk for heart attacks and strokes."
In the ARIC group, about half of people older than 75 were still taking statins, the letter authors noted.
Dr. Miedema told dailyRx News he takes each patient's health into account when he considers prescribing statins.
“For individuals above age 75, I tend to individualize the approach," he said. "If you are a 'young' 80 year old and have risk factors for heart disease, I tend to recommend statin therapy to lower your risk of a future event. However, if you are more frail or have multiple chronic disease, I tend to focus on quality of life and don't want to take the risk of statin side effects.”
Possible side effects of statins include muscle pain, liver damage and high blood sugar, among others, according to the Mayo Clinic website. Some common statins are atorvastatin, (brand name Lipitor), fluvastatin (Lescol) and pravastatin (Pravachol).
Current recommendations on statin use are not conclusive and more research is needed, Dr. Miedema and colleagues said.
The current study was published Nov. 24 in JAMA Internal Medicine.
Study author Christie M. Ballantyne received funding from several sources, such as Novartis and Roche. The authors made no other disclosures.