The American Heart Association and the American College of Cardiology have published new guidelines to reduce the risk of atherosclerotic heart disease in Americans by the treatment of high cholesterol, and they recommend giving more Americans statin drugs which are designed to lower the “bad” LDL cholesterol. Currently, statin drugs are the most commonly prescription drug filled in the U.S. which add up to over $10.0 billion in costs.
Approximately 40 million Americans are taking a statin drug today. This new recommendation will essentially double the number of people in the U.S. who would be taking a statin drug such as Lipitor, Zocor or Crestor. The new recommendation would include approximately 33 million Americans without heart disease but who have a 7.5% risk or higher of experiencing a heart attack or stroke within the next 10 years.
These guidelines replace the previous 2002 guidelines which recommended that people with a 10 year risk profile over 20% consider statin treatment.
The people targeted in this guideline include:
- People without heart disease aged 40-75 who have a 7.5% risk or higher of suffering a heart attack or stroke
- People with a history of heart disease or stroke
- Adults over 21 with very high LDL cholesterol
- People who have diabetes and are between 40-75 years old
There are two distinct groups of people who are included in this guideline: those who are thought to benefit from the primary prevention of a heart attack or stroke by using statin drugs and those who have a disease and need to prevent further disease complications by taking statin drugs.
The new guidelines for primary prevention now include a much wider population of people. In order for this to be an effective strategy, large groups of people would have to be treated for 10 years to decrease the incidence of a heart attack or stroke in just a few of them.
For instance, females over 60 who smoke and have high blood pressure would now be recommended to take statin drugs. Would it not make more sense to focus upon smoking cessation strategies for these folks?
The research regarding using statin drugs to prevent a dangerous vascular event (not death) in an otherwise healthy population is scanty at best. You also must consider the total effect of risk of the treatment versus potential harms relative to other forms of prevention.
Research has shown that lifestyle interventions like diet, supplements, stress reduction, and exercise are more effective than drug therapy—and safer. The side effects of long term use of statin drugs are also under-reported in the literature so it may be a much better option for Americans to make healthy lifestyle changes.
In my opinion, you can safely and adequately lower your own individual risk profile for cardiovascular disease by changing your lifestyle, taking a few inexpensive supplements like fish oil, and being pro-active in the areas of stress reduction, alcohol consumption, and smoking cessation.
In those people who need secondary prevention, the use of a statin drug makes better sense under certain circumstances as this drug can help these groups of patients. However, in my view, a combined approach involving lifestyle intervention and medical management is the most effective one to consider.
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Brown, M., “New Guidelines Propose Significant Shift in Cholesterol Management,” AAFP web site; http://www.aafp.org/news-now/health-of-the-public/20131115accahaguidelines.html,last accessed Nov.18, 2013.
“New heart disease and stroke prevention guidelines released,” American Heart Association web site; http://blog.heart.org/new-heart-disease-and-stroke-prevention-guidelines-released/,last accessed Nov.18, 2013.
“Statements and Guidelines,” American Heart Association web site; http://my.americanheart.org/professional/StatementsGuidelines/ByPublicationDate/CurrentYear/Current-Year_UCM_322835_Article.jsp,last accessed Nov.18, 2013.