Roxana Mehran, MD, Professor of Medicine, Director of Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai
The Status of Statins: Many More People Could Benefit From Anti-Cholesterol Drugs
In the last 10 years, statin drugs have emerged as important tools in lowering the risk of heart attack and stroke without causing significant side effects. However, cardiovascular diseases still account for about one in every three deaths in the United States. This has led over the past few years to more liberal use of statins for the prevention of heart attacks and strokes. Keeping pace, the United States Preventive Services Task Force recently issued new guidelines recommending that many more people take statins, including those who are at risk for cardiovascular disease but have no signs, symptoms, or history of it.
What Are Statins?
Low-density lipoprotein, or LDL, cholesterol is commonly called “bad” cholesterol. Too much of it in the blood can lead to clogged arteries, increasing the risk of heart disease. Statins are a class of medications that reduce the amount of LDL cholesterol produced and released into the bloodstream by the liver. Such drugs approved for use in the United States include atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
Statins are proven to reduce the risk of cardiovascular events over the long term. They are affordable and usually well tolerated. However, as with any drug, they are not free of side effects. Statins may cause muscle pain, which usually goes away when the medication is stopped or the dose is lowered. They also may cause liver or kidney damage, although that is rare and can be monitored with lab tests at the beginning of treatment and periodically thereafter.
For many years, statins were used only in patients with high blood cholesterol levels, meaning those with LDL levels greater than 100 mg/dL, and then only if dietary and lifestyle changes had failed to get the patient’s cholesterol under control. More recently, high-intensity statin treatment has become the standard for most patients with known cardiovascular disease. In its new statement, the U.S. Preventive Services Task Force now recommends low- to moderate-dose statins for the prevention of cardiovascular diseases in people at risk, regardless of whether they have a history of heart disease or high cholesterol.
Who Is at Risk?
You are considered at risk of heart disease if you are 40 to 75 years old, have one or more cardiovascular risk factors—high cholesterol, diabetes, high blood pressure, or smoking—and have a 10 percent or greater chance of suffering a heart attack or stroke in the next 10 years. (Your doctor can estimate the risk of such cardiac events using a risk assessment tool provided by the American College of Cardiology/American Heart Association.)
The Task Force did not make a recommendation for patients over 75, because there is not enough evidence to assess the benefit versus harm of using statins for primary prevention at that age. The new recommendations also do not apply to patients with a genetic disorder called familial hypercholesterolemia, or those with cholesterol levels higher than 190 mg/dL, as they might need high-intensity statin treatment.
Who Should Take Statins?
Anyone over 40 should have their risk profile for cardiovascular diseases evaluated by their primary care doctor. If it turns out you have at least one cardiovascular risk factor and a 10 percent estimated risk of cardiac events, discuss and consider starting lifelong, low- to moderate-intensity statin treatment, together with lifestyle and dietary changes. Taking a pill a day indefinitely can be annoying for relatively young people with no known cardiac disease. However, statins can improve cardiovascular health, and save lives, by preventing heart attacks and strokes, so the long-term benefit may outweigh the potential side effects and annoyance of using medications.
They Can Only Do So Much
While much data supports statin therapy, we need to think of these medications as a helping hand. Statins should not replace habits like eating a healthy diet, exercising, getting enough sleep, reducing stress, and not smoking. Making these important changes could make a huge difference down the line. The latest study shows that even genetic risks can be overcome by a healthy lifestyle.
It is also very important to realize that cardiovascular disease is no longer considered a “man’s disease”; understanding risk factors and implementing a prevention plan applies to women, as well.
It will take time for the effects of the new recommendations to become apparent, but we should eventually see a reduction in cardiovascular diseases in the American population. And that will mean fewer hospitalizations and follow-up visits, less medication use, and longer lives.