New Guideline Could Double Statin Use

UPDATE: March 20, 2014. Researchers at Duke University have calculated that 56 million Americans between 40 and 75 years old would be eligible for statins under November's guidelines, compared with 43 million under the old guidelines. Of the newly eligible, 10.4 million would be those that have never shown cardiovascular symptoms, but would be taking the drugs preventative.  They note, however, that because these new guidelines are less specific, it may also lead to overtreatment of many patients.

The data comes from a study of 3773 participants in the National Health and Nutrition Examination Survey from between 2005 and 2010.

Rather than a goal of simply lowering “bad” LDL cholesterol levels, the new guideline targets those at highest risk for a heart attack or stroke. This means that some people no longer need to take the drugs, while others will be prescribed higher doses.
The guidelines say that statins—ie, Lipitor, Mevacor, Crestor, and Zocor—would provide the most benefit for patients with a history of cardiovascular disease, type 2 diabetics between the ages of 40 and 75, LDL cholesterol levels of 190 mg/dL or more, and those with a 10-year cardiovascular risk of 7.5% or above who are between 40 and 75 years of age, assessed using a a new equation.

The dosage of statin therapy varies: Patients with a history of cardiovascular disease or high LDL cholesterol levels should start a high-intensity statin treatment, while those with high 10-year risk would be recommended moderate statin therapy.

Conversely, the new guidelines step away from the previous protocol of relying on a low dose statin in conjunction with other cholesterol medications. Instead, practitioners should focus on a healthier lifestyle and prescribe higher-dose statins with no additional cholesterol medication.

Practitioners are asked to provide patients with instructions on a low-caloric healthy diet of fruits, vegetables, whole grains, low-fat dairy, fish, poultry, and nuts that is low in sugary drinks and red meat—as well as recommend 40 minutes of exercise 3 to 4 days a week to help reduce heart risk.

While the new guidelines might lower the number of people put on statins based on cholesterol levels alone, it would also likely double the number who qualify for statin treatment to more than 70 million people

“Most importantly, our focus is on those individuals most likely to benefit from evidence-based statin therapy to reduce atherosclerotic cardiovascular risk (ASCVD) risk,” the authors said. “Implementation of these ASCVD risk reduction guidelines will help to substantially address the large burden of fatal and nonfatal ASCVD in the United States.”

–Michael Potts

Reference

Stone NJ, Robinson J, Lichtenstein AH, Blum CB, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.11.002