Statins May Benefit More People

Cholesterol-lowering statin drugs should be prescribed to more Americans at risk for heart disease.

Cholesterol-lowering statin drugs should now be prescribed to an estimated 33 million Americans without cardiovascular disease who have a 7.5 percent or higher risk for a heart attack or stroke within the next 10 years. That’s according to a new cholesterol guideline from the American Heart Association and American College of Cardiology.

This is a dramatic change from the 2002 federal cholesterol guideline, which recommended that people should only take a statin if their 10-year risk level exceeded 20 percent. The old guideline only considered a person’s risk for heart disease, leaving out the risk for stroke.

Statins are drugs that lower the amount of cholesterol circulating in the blood. Seven statin drugs are currently available in the U.S.

Estimates of Americans needing statin therapy now higher.

“We’ve been under-treating people who need statin therapy in this country,” said American Heart Association volunteer Donald Lloyd-Jones, M.D., one of 20 experts on the committee that wrote the new guideline.

Examples of groups that would exceed the 7.5 percent risk threshold and therefore benefit from statin therapy include white women over 60 who smoke and have high blood pressure and African-American men over 50 with high blood pressure.

Recent research on statins also suggests side effects are rare.

“Statins lower cholesterol levels, but what they really target is overall cardiovascular risk,” said Lloyd-Jones, a preventive cardiologist and chair of the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Risk of heart attack drops 20 percent for each 39 mg/dL reduction in bad LDL (cholesterol).

Ideally, the level of bad (LDL) cholesterol should be below 100 milligrams per deciliter of blood (mg/dL). It is considered high at 160 mg/dL. For someone taking a statin, the risk for a heart attack or stroke drops by about 20 percent for each 39 mg/dL reduction in bad (LDL) cholesterol, according to the guideline. Bad cholesterol is considered high at 160 mg/dL.

Statin therapy patient recommendations

The guideline recommends statin therapy for the following groups:

• People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.
• People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.
• People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
• People with Type 1 or Type 2 diabetes who are 40 to 75 years old.a