Who Should Take Statins
The guidelines around who should take statins have changed over the years.
In Ireland, the 1987 guidelines put about 8 percent of people 50 or over eligible for the drugs. By 2016, that number increased to 61 percent, the researchers reported.
The new study suggested people classified as low or moderate risk for cardiovascular disease wouldnt reach acceptable cholesterol risk levels to justify taking statins.
The study authors said the use of statins in these people warrants more careful consideration, and that the concepts of overuse and low value care should become integral to policy making and resource allocation decisions.
Some experts point out that in the United States, medical guidelines say the benefit of using statins in people with a low or medium risk really isnt always justified.
The current American College of Cardiology guidelines for statin use emphasize collaborative decision-making between providers and patients, Tomas Ayala, MD, FAAC, a cardiologist at Mercy Medical Center in Baltimore, Maryland, told Healthline.
In general, statins are not recommended for low-risk patients. For patients at high risk statins are recommended for primary prevention of cardiac events. For those of immediate risk, statins are recommended only if the patient also has a high-risk illness, such as diabetes, peripheral vascular disease, or cerebrovascular disease.
So, as you see, the current recommendations are really in line with whats being described, Ayala said.
Statins May Save Lives For Secondary Prevention:
Lets make one thing absolutely clear. I have been talking mostly about primary prevention, not secondary prevention. Whats the difference between these two situations?
If someone has experienced a heart attack or has diagnosed cardiovascular disease, we think a case could be made for statins in what doctors call secondary prevention. Thats because people who have clearly defined heart disease or have had heart attacks or strokes may benefit from drugs like atorvastatin, simvastatin or rosuvastatin. The goal is to prevent a secondaryevent.
What follows is not about that. Instead, we are reporting on people who are otherwise healthy but might have elevated cholesterol levels. Guidelines often encourage doctors to prescribe statins to older people just because of their age. Even if their cholesterol levels are good and their blood pressure is under control, they may be prescribed statins just in case. This is called primary prevention.
Who Needs To Take Statins
Your healthcare provider will look at your individual situation when deciding if you should take a statin. Having diabetes, high blood pressure or high cholesterol and using tobacco products are all risk factors for getting heart disease. Your provider will also consider your age, sex and race when deciding if you need a statin.
Providers prescribe statins for people who:
- Have high cholesterol that exercise and diet changes couldnt reduce.
- Had a stroke, heart attack or peripheral artery disease.
- Have diabetes and an LDL of at least 70 mg/dL and are 40 to 75 years old.
- Have an LDL of at least 70 mg/dL and a high risk of getting heart disease and are 40 to 75 years old.
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Statins In The Prevention Of Cardiovascular Disease And Heart Failure
Some of these trials do allow us to look at incident heart failure. Collectively, these trials provide reasonable evidence that statin use can prevent or delay the onset of HF . This therapeutic link is based on the supposition that statins prevent MI and consequent cardiac damage and so reduce the risk of developing reduced ejection fraction HF. A meta-analysis of 6 randomized controlled trials of 110,271 patient-years in patients with recent acute coronary syndrome showed that intensive statin therapy reduced hospitalization rates for HF . Further, in a larger collaborative meta-analysis of up to 17 major primary- and secondary-prevention randomized trials with 132,538 participants conducted over 4.3 years, statins modestly reduced the risks of non-fatal hospitalization for HF and the composite of non-fatal hospitalization or death from HF 1c) but not HF death 1b) . There was no demonstrable difference in risk reduction between those who suffered an incident MI or not . Interestingly, therefore, this benefit did not seem to be due to prevention of MI preceding HF.
Myth #: The Benefits Of Statins Outweigh The Side Effects
No, actually, they dont. Ive seen plenty of studies showing that statins cause serious side effects that can be nothing short of disastrous, including:
- Increased risk of diabetes
- Acute kidney failure
- Serious memory problems, including transient global amnesia , a condition that can eliminate nearly all memory and sometimes lasts for days
Myth #: Statins Reduce Deadly Inflammation So They Help Keep You Healthy
Lowering inflammation, which is believed to be the root cause of all illness including heart disease does benefit your health, but statins are not the way to do it.
Neither are non-steroidal anti-inflammatories , like ibuprofen and aspirin. Even though theyre sold over-the-counter, those bad boys have plenty of downsides, including internal bleeding and vision damage.
Safe, natural anti-inflammatories like omega-3 essential fatty acids and curcumin, an extract of the spice turmeric, are far safer choices.
And in addition to lowering inflammation, both omega 3 EFAs and curcumin enhance your health in other ways, easing aches and pains, depression, helping with weight management, and more.
I recommend taking 1,000 mg of omega-3s daily. Add a daily dose of 1,500 mg of curcumin, from a product with increased bioavailability to enhance absorption, and your chronic inflammation will be history.
Do Statins Cause Side Effects
There is also a growing effort to convince physicians and patients that statins do not cause side effects. This is not the first time.
An article in the European Journal of Preventive Cardiology concluded:
Only a small minority of symptoms reported on statins are genuinely due to the statins: almost all would occur just as frequently on placebo.
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Research Asks Whether Statins Save Lives:
A previous meta-analysis published in JAMA Internal Medicine shows that if 100 healthy people between 50 and 75 years of age take a statin for 2.5 years, there will be one less cardiovascular event among that group. The data do not show that statins save lives for primary prevention.
This research focused on people over 55 years of age. They located eight randomized controlled trials involving 65,383 adults. The researchers followed up the subjects for 2 to 6 years, on average.
How Common Are The Side Effects Of Statins
As with all drugs, statins carry a risk of side effects. The most common is muscle ache or pain. About 10 percent of people on a statin will develop this, although it is usually fairly mild, and it is entirely reversible without causing damage to the muscle when the drug is discontinued. In 1 out of 10,000 cases, a patient on a statin will develop serious pain and muscle damage. This is so rare that Ive never seen it in a patient.
Typically, we can eliminate the muscle aches by changing the dose of the statin or switching to a different statin, as the molecular structures of statin medications can be quite different. We usually can find one a patient can tolerate well without side effects.
Other side effects can include increased risk for diabetes and liver damage, but these are also quite rare.
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Myth #: Statins Are The Best Way To Protect Against A Heart Attack
Wrong again! According to a recent study reviewing earlier, high quality research on statins, the drugs are worthless in terms of preventing a first heart attack, although they have been shown effective at preventing a second.
But there is one thing that works and it doesnt come with a long list of side effects and concerns.
Lifestyle changes, including stopping tobacco use, eating a nutritious, whole-foods diet, participating in moderate exercise regularly, and practicing stress management cant be beat when it comes to protection against heart disease, not to mention most other chronic conditions, including cancer.
I know its difficult to give up favorite foods and change lifelong habits. But my recommendations are based on solid science. There is no longer any doubt that how we live affects how well we age and what diseases we develop.
When you choose to sit on the couch instead of going for a walk, or choose a cheeseburger and fries instead of healthier fare, youre choosing heart disease, cancer, high blood pressure, diabetes, or another health issue that we know is caused by lifestyle.
Heres the bottom line: Avoiding heart disease and living a long, healthy, active life starts with you, not a prescription pad. I hope you start today!
August 16, 2018Originally Published: September 9, 2014
Do Statins Save Lives Doctors Dont Agree
Many people wonder how effective statins are for preventing a heart attack in healthy people with high cholesterol. Even more important, do statins save lives in this population? There are few more controversial questions in medicine. Thats because tens of millions of people take statins, presumably to prevent heart attacks and lengthen their lives. Has this promise been broken? A study in JAMA Internal Medicine suggests that statins are not as great at preventing heart attacks as most clinicians believe.
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Do Statins Prevent Heart Attacks And Strokes
Statins are prescribed to people who have a high risk for heart attack and stroke. They are thought to prevent these conditions by reducing the amount of cholesterol in the blood, but they come with side effects such as muscle pain, weakness, and rashes that may also be reduced by healthy living choices.
This article will provide an overview of what statins do and to help you better discuss the subject with your physician.
What Are Statins?
Statins are a class of drugs called HMG-CoA reductase inhibitors. There are several other classes of drugs within this category that include some commonly prescribed cholesterol lowering medications such as Zocor and Zetia. They work by blocking an enzyme called 3 hydroxymethylglutaryl CoA reductase , which is responsible for the conversion of LDL cholesterol to the more harmless HDL cholesterol. This allows more LDL cholesterol to be cleared from your blood, making less available for the body to attack and damage. The idea is that this in turn will reduce the amount of plaque build up in your arteries and help prevent heart attacks and strokes. Some studies suggest that taking statins may help people live longer as well.
How Do I Know If I Need Statins?
Youre probably wondering how you know if you need statins. This class of drugs is typically only prescribed to people who have a 10-20% chance of having a heart attack or stroke within 10 years.
How Do I Take Statins?
Why Do Some People Not Need Statins?
Do Statins Prevent Stroke?
Statins Lower Heart Attack Stroke Risk In People At Average Risk
Please note: This article was published more than two years ago, so some information may be outdated. If you have questions about your health, always contact a health care professional.
Editors note: This is one in a 10-part series of the top medical research advances of 2016 as determined by the American Heart Association.
Millions more people worldwide may benefit from cholesterol-lowering statins after a global study showed the drugs help reduce heart attacks and strokes in people at moderate risk. The risk fell slightly further when patients also took blood pressure drugs.
Medications to lower blood pressure have been shown to reduce the risk of heart disease in people with elevated blood pressure and those at high risk, and statins have been shown to benefit those at high risk. But a group of researchers wanted to know if treating each condition alone or simultaneously might prevent heart attacks and strokes in an ethnically diverse group of average-risk people without cardiovascular disease.
HOPE-3s findings reinforce 2013 guidelines from the AHA and American College of Cardiology that recommend statins for more people.
Based on these latest findings, about 300 million people worldwide could be eligible for statin treatment, estimates Salim Yusuf, M.D., D.Phil., the studys lead investigator and professor of medicine at McMaster University in Canada.
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Latest Statins Guidance Keeps More Conservative Approach To Preventing First Stroke Or Heart Attack
The US Preventive Services Task Force on Tuesday announced its latest guidelines on the use of statins to prevent a first heart attack or stroke. The recommendations are virtually unchanged from prior guidance but are now supported by additional research, the group said.
The recommendations are a little more conservative than guidelines put out by the American College of Cardiology and the American Heart Association, and some doctors wonder if they should be more aggressive.
Heart disease is the number one killer for men and women in the world. One person dies every 34 seconds in the US from cardiovascular disease, according to the US Centers for Disease Control and Prevention.
Potential Mechanisms By Which Statins Prevent Hf Development
Statins are believed to lower CAD by stabilizing atheromatous plaques, reduction of atheroma volume, and prevention of formation of new atherosclerotic lesions resulting in fewer MIs and less associated cardiac tissue damage. This may be the main way statins lower incident HF. We looked further at this in the long-term follow-up of WOSCOPS 2) where, as noted before, it appeared that statin use decreased the incidence of HF. In a companion report, we found that pravastatin reduced high-sensitivity troponin I concentration by 13% and troponins also predict incident HF. Thus, it is theoretically possible that statins lessen subclinical ischemia and cardiac damage . Whilst others have proposed a number of pleiotropic actions of statins , there is no clear evidence for this contributing to clinical benefit .
Proposed mechanistic pathways on how statins reduce heart failure: by reducing myocardial infarction by reducing subclinical ischemia . Abbreviations: LDL, low-density lipoprotein
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Straight Talk About Statins
Tens of millions of Americans take a statin widely considered the gold standard for treating high cholesterol along with heart-healthy choices like eating right and getting regular exercise.
Beyond helping to lower cholesterol, statins can also help prevent heart attacks and stroke two leading causes of disability and death.
Yet, even though statins are one of the most prescribed medications, they are often misunderstood. Our experts help clear up some common misperceptions about their use.
- Last Edited 08/26/2021
The Task Forces Guidance
Specifically, the USPSTF guidance published Tuesday in JAMA recommends statins for adults ages 40 to 75 who have one or more risk factors of cardiovascular disease and a 10% or greater risk of having a heart attack or stroke in the next 10 years. Those risk factors include diabetes, high blood pressure, smoking or high cholesterol. To calculate a persons risk score, doctors also take into account factors like a persons age, sex, race, blood pressure, cholesterol numbers and family history.
For people who have a slightly lower 7.5% to 10% risk of having a heart attack or stroke in the next 10 years, the latest guidance recommends that they talk to their doctor and then decide if they should take statins.
Because the risk is slightly lower with this group, the benefits are smaller, even though they are still effective. In this case, the patient should talk to their doctor to determine if, based on individual factors, they need to take one. There are other factors at the individual level that a healthcare professional and a patient can together decide what might be best for that patient because there are other ways of lowering your risk for having a stroke or first heart attack, according to task force member Dr. John Wong, a professor of medicine at Tufts University. That includes things like diet and exercise.
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What Other Guidelines Recommend
An editorial that accompanied the recommendations in JAMA suggested that these guidelines should have been more aggressive and better matched to cholesterol guidelines recommended by the American College of Cardiology and the American Heart Association. Those guidelines recommend statins for adults ages 40 to 75 who have a 7.5% or greater risk of having a heart attack or stroke in the next 10 years, as opposed to a 10% risk. The ACC/AHA guidelines also recommend statins for patients with diabetes without having to also calculate a persons 10-year risk score and recommend statins for those patients with extremely high levels of cholesterol.
Individuals with higher baseline risks have greater absolute benefits from intervention than the lower-risk population. Were statins either risky or expensive, such a tailored treatment strategy would be reasonable. However, statins are now available as generic drugs and are both safe and affordable, wrote the doctors at University of Texas Southwestern Medical Center in Dallas in an editorial.
Dr. Edward Fry, the president of the ACC, said it is important to keep in mind that the USPSTF guidelines are statements that are to be applied to a broad group or population of patients, whereas the ACC/AHA guidelines are directed more toward the individual. Neither make statins an automatic decision for a patient.
Statins Reduce Deaths From Heart Disease By 28 Per Cent Says Longest Ever Study
by Caroline Brogan06 September 2017
The study focused on men with high levels of ‘bad’ cholesterol and no other risk factors or signs of heart disease
Previous research has shown the benefit of statins for reducing high cholesterol and coronary heart disease risk amongst different patient populations. However, until now there has been no conclusive evidence from trials for current guidelines on statin usage for people with very high levels of low density lipoprotein cholesterol and no established heart disease.
Our findings provide the first trial-based evidence to support the guidelines for treating patients with LDL above 190mg/dL and no signs of heart disease.
Professor Kausik Ray
School of Public Health
After studying mortality over a 20-year period, researchers led by Professor Kausik Ray at Imperial in collaboration with the University of Glasgow showed that 40mg daily of pravastatin, a relatively weak type of statin, reduced deaths from heart disease in participants by more than a quarter.
Senior author Professor Ray from Imperials School of Public Health said: For the first time, we show that statins reduce the risk of death in this specific group of people who appear largely healthy except for very high LDL levels. This legitimises current guidelines which recommend treating this population with statins.
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