When guidelines were changed to recommend more patients take statins to lower their cholesterol, some doctors worried that too many would be taking the drugs unnecessarily. Now studies are showing that wider use of statins did, in fact, help save more lives.
Under previous guidelines, doctors would decide which patients needed a statin prescription based on their low-density lipoprotein cholesterol (LDL) levels. Sometimes called bad cholesterol, this substance can build up on artery walls, restricting blood flow and potentially causing a heart attack or stroke. With an increased level of LDL in their blood, patients would be more at risk of these health problems.
In 2013, however, the American College of Cardiology and American Heart Association changed their recommendations for who should get a statin prescription. They instead started recommending doctors prescribe statins to their patients who are between the age of forty and seventy-five, both men and women, who have a seven and a half percent higher risk of having a heart attack or stroke in the next decade. Their risk calculator takes into consideration cholesterol levels in the body, blood pressure, weight, gender, and whether the patient smokes, among other factors.
Critics argued that the calculator tended to overestimate a patient’s risk of a heart attack or stroke. This would mean that patients would take statins needlessly, raising their risk of side effects such as muscle pain and diabetes. As well, some worried that patients would rely too much on pills to control their cholesterol levels, instead of diet and exercise which have other health benefits beyond lowering cholesterol.
After a couple years with the new cholesterol drug guidelines, two studies published in the Journal of the American Medical Association set out to determine once and for all if the new guidelines were better or worse than the old. By looking at 2,435 patients in the Framingham Heart study who were not taking a statin, the researchers determined that 14% would be eligible for a statin prescription under the old guidelines versus 39% under the new guidelines. They then compared the number of heart attacks, strokes, and cardiovascular disease deaths under each set of guidelines. They found that under both the old and new cholesterol drug guidelines, about 6% of patients had these health problems. The similarity of that number between both groups suggests that under both sets of guidelines, too many people would not be taking the statin drugs unnecessarily. However, under the old guidelines, 2.4% of patients who were not eligible for a statin prescription had a heart attack or stroke, versus just 1% under the new guidelines. Those numbers suggest that under the old guidelines, more patients were missed who would benefit from statins.
The studies suggest that the new statin guidelines are on the right track to reduce the chance of heart attack or stroke for those at risk. While doctors prefer patients try to lower their cholesterol through diet and exercise, some patients need even more help to lower their LDL cholesterol.
The studies went beyond determining if patients were taking statins unnecessarily. They also looked at the cost of statin drugs versus the quantity and quality of life for patients, determining that statins are cost-effective. This is aided by the availability of generic versions of some of the more popular statin drugs like Lipitor or Crestor.
Generally, taking a statin can lower a patient’s risk of a heart attack or stroke by about 20%. This means if the patient had a 5% risk of cardiovascular disease, the drugs would lower their risk to about 4%. However, for patients with a risk above 7.5%, the statins would be even more beneficial.
Statins work by reducing the production of LDL cholesterol in the body and by increasing the body’s uptake of cholesterol, thus reducing the amount that is running through the arteries. This reduces the chance that the cholesterol can build up and clog the arteries, causing a heart attack or stroke.