Don't get caught on 'statin' island

Statins, traditionally sound medications prescribed to help prevent heart disease, may benefit even more people if new guidelines are put in place.

Statins are medications that are intended to lower cholesterol in at-risk patients. The American Heart Association (AHA) recently released new guidelines for prescribing them—guidelines that also factored in variables like age, blood pressure, diabetes and overall lifestyle. The new guidelines also included a risk calculator designed to evaluate a patient’s risk of developing heart disease during their next 10 years.

Some physicians have since argued that the risk calculator is flawed and could lead physicians to over-prescribe statins.  There are about 36 million Americans on statin medications now; the new guidelines could double that number.

"The biggest criticism has been that it might just be too many people,” said Michael Kalata, MD, a cardio vascular disease specialist with Oakwood Healthcare. “But I haven’t found a strong basis for that criticism.”

Samir Dabbous, MD, an interventional cardiologist and Chief of Cardiology at Oakwood Physicians (OPi), said that the new guidelines make sense because they factor in the patient’s total health, rather than concentrate on an arbitrary numeric guideline.

“Physicians always focused on getting a patient’s bad cholesterol, or HDL, to less than 70,” he said. “Today we know that there is no magic number. We try to bring these HDL levels down a certain percentage and look at other factors in order to better assess a patient’s overall risk for heart disease.”

Under the new guidelines, he said some patients currently being prescribed statins may be able to discontinue them while others may be advised to begin statin therapy. The patient’s primary care physician or cardiologist can determine what an appropriate LDL level may be for their patient and develop the proper treatment based on all those health and risk factors.

“This new calculator puts the focus on addressing other risk factors, which can help physicians and patients manage their risks more easily,” said Dabbous. “There is no one approach that will work for every patient. It’s important for people to talk to their physicians—and for physicians to listen to them—so that they can establish a plan that works best for each individual patient.”

Dabbous said that medications such as statins may help, but they are only part of the equation. He said it is also important for patients to make appropriate lifestyle changes: in general, eat better and get more active, exercising between 30-40 minutes three to four times a week.

“As physicians, we must educate diabetic patients about how to lower their blood sugar; we must encourage smokers to quit smoking and we must teach patients with high blood pressure how to adjust their diet to bring it down.”