Related: Could This Widely Used Calculator Be Needlessly Driving People To Take Statins
In theory, the formulas estimate an individuals risk of having a heart attack or stroke during the next decade. High risk is defined as a risk greater than 7.5%. But how accurate are these predictions? One study of more than 300,000 adults predicted that 8.7% of high-risk individuals would have a heart attack over the next five years. Yet only 1.8% of them did. The standard calculator wildly overestimates risk.
The real question that anyone taking a statin, or thinking of taking one, should ask is this: Will taking a cholesterol-lowering medication protect me from dying prematurely? The answer is a qualified yes. Many studies have shown that statins reduce the risk of dying from heart disease. But thats not saying as much you think. The estimated benefits have been exaggerated and, worse, the side effects may have been understated.
Lots of clinical trials have been conducted in which people are randomly assigned to take a statin or a placebo enough to generate large meta-analyses, impartial studies of the studies. Those that focus on deaths from cardiovascular disease typically conclude that statins save lives. Others focus on death from any cause. I favor this measure because I keep my eye on my goal: I dont want to die young. If a medicine reduces my chances of dying of heart disease but increases my chances of dying from other causes, it might not be an attractive treatment.
Data Extraction And Quality Assessment
Two authors independently conducted the literature search, study selection, and data extraction. The extracted data of the included studies was entered into a standardized table prepared for this review. The extracted data included the first author, publication year, participant types, sample size, sex, age, interventions in the treatment and control groups, dosage of medications, follow-up time, outcomes, and so on. Disagreements were discussed and resolved at a consensus meeting with the corresponding author. In addition, according to the Cochrane Reviewer’s Handbook, the two authors individually assessed the risk of bias. Six evaluation criteria for the quality of RCTs were used, which included generation of a random sequence, randomization concealment, blinding method, integrity of the outcome data, selective reporting and other bias. Each quality item was graded as low, unclear or high risk.
The Status Of Statins
They reduce harmful cholesterol, but should healthy women be taking them?
Where would we be without cholesterol? It’s a vital component of cell membranes and nerve sheaths. It forms the basis of sex hormones. It enables bile acids to process the food we eat. As Martha Stewart might say, “It’s a good thing.” But since the mid-1960s, we’ve learned that we can have too much of a good thing. Medical research has demonstrated that excess levels of cholesterol in the blood can lead to atherosclerosis, heart attacks, and strokes.
Healthier living can reduce cholesterol levels, but by only so much. If levels are very high or must be brought down rapidly, more is needed. Billions of dollars and years of research have gone into developing an ideal drug for reducing cholesterol specifically LDL cholesterol, the bad kind. In 1987, with the introduction of lovastatin , it appeared that the magic pill had arrived.
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Potential Benefits Of Statin Use
The USPSTF found adequate evidence that use of low- to moderate-dose statins reduces the probability of CVD events and mortality by at least a moderate amount in adults aged 40 to 75 years who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 10% or greater.
The USPSTF found adequate evidence that use of low- to moderate-dose statins reduces the probability of CVD events and mortality by at least a small amount in adults aged 40 to 75 years who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10%.
The USPSTF found inadequate evidence to conclude whether initiating statin use in adults 76 years and older who are not already taking a statin is beneficial in reducing the incidence of CVD events and mortality.
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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Statins In The Treatment Of Established Heart Failure
Not satisfied with the above trial evidence, a number of investigators have attempted to examine if statin therapy has any role in patients with established HF by examining randomized trials in a number of meta-analyses. For example, Zhang et al. reported no significant reduction from statin therapy for all-cause death, CV death, or rehospitalization for HF, but a non-significant trend to lower non-fatal MI . Notably, however, CAD events are relatively uncommon in HF in general, even in ischemic HF, and are a minor contributor to the overall morbidity and mortality in patients with this condition . The same group also investigated whether statin therapy had an effect on measures of left ventricular size and function, this time collating 11 RCTs totaling 590 patients . Here they reported that statin use increased LVEF by 3% but notably, some of the trials were of modest quality, and there was considerable heterogeneity in the findings, so definitive conclusions cannot be made. Thus, whilst the best evidence suggests statins do not improve outcomes in patients with HF, clinicians generally continue HF patients on statins as most are not comfortable stopping them, unless statin-related complications arise.
Study Inclusion And Exclusion Criteria
We included all randomized controlled trials , and the publication language was either English or Chinese. Participants without a clinical history of CHD were included, age and race were not limited. The treatment group was given statins alone or combined with usual care, and the control group was given nothing, placebo, or usual care. Usual care was generally determined based on the specific disease of the participants for example, patients with diabetes will be given hypoglycaemic agents such as metformin, and patients with hypertension will take captopril or other antihypertensive medicines. If we did not know whether the participants had CHD, these articles were excluded. In addition, we also excluded articles without full text. Moreover, the primary outcomes in this systematic review mainly included angina, nonfatal and/or fatal MI, any coronary heart events, coronary revascularization, and CHD deaths. The secondary outcomes involved any cardiovascular events, CVD deaths and all-cause mortality. We also reported the adverse events, which mainly comprised cancer, diabetes, gastrointestinal/hepatic/renal disorder, myalgia, myopathy, rhabdomyolysis, alanine aminotransferase , aspartate aminotransferase , creatine kinase , and so forth. The results of the included studies must involve at least one of the primary outcomes.
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Why Have I Been Offered Statins
Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries and cardiovascular disease .
CVD is a general term that describes a disease of the heart or blood vessels. It’s the most common cause of death in the UK.
The main types of CVD are:
- coronary heart disease when the blood supply to the heart becomes restricted
- angina chest pain caused by reduced blood flow to the heart muscles
- heart attacks when the supply of blood to the heart is suddenly blocked
- stroke when the supply of blood to the brain becomes blocked
A doctor may recommend taking statins if either:
- you have been diagnosed with a form of CVD
- your personal and family medical history suggests you’re likely to develop CVD at some point over the next 10 years and lifestyle measures have not reduced this risk
Find out more about when statins may be recommended.
How To Know If You’re At Risk
If you are in one of these four high-risk categories, new cholesterol guidelines say taking a statin could help you avoid a heart attack or stroke:
- You’ve been diagnosed with heart disease or already had a heart attack.
- Your level of LDL, the harmful type of cholesterol, is 190 mg/dL or higher.
- You have type 1 or type 2 diabetes and your LDL is 70 mg/dL or higher.
- Your risk of having a heart attack or stroke in the next 10 years is 7.5 percent or higher, according to the guidelines’ controversial new health risk calculator.
Some critics lambasted the calculator for overestimating a person’s risk, saying it could result in millions of people unnecessarily being prescribed statins. Others questioned whether statins should even be prescribed to prevent heart disease in relatively healthy patients.
Meanwhile, patients have been bombarding doctors with some basic questions. Here are answers from some leading medical experts:
Should I be on a statin?
“If your only risk factor is your age, you may not need to be on a statin,” said Michael Blaha, M.D., director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.
Harvard’s John Abramson, M.D., author of Overdosed America, acknowledges that taking a statin can reduce your risk, but not by a lot. “Treating 140 people with less than a 20 percent risk for five years will prevent one heart attack or stroke.” He favors focusing more on preventing a heart attack through lifestyle changes.
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Lifestyle Changes To Benefits Your Heart Health
Statins remain the gold standard to help those with high cholesterol manage their cholesterol levels and reduce the risk of cardiovascular events. However, in some cases, patients are unable to use statins due to adverse effects. Fortunately, there are studies and ongoing clinical trials to explore the effectiveness of non-statin cholesterol lowering drugs.
Whether or not you choose to take a statin, how you live your life can make a significant impact on your heart health by preventing or delaying heart disease. Some things you can do:
New Study Adds To Debate Over Statin Use To Prevent Cvd
The authors say while guidelines look at the benefits of statins to prevent cardiovascular disease , they do not adequately assess the harms. The new model takes this into account.
The 2013 recommendation from the American College of Cardiology and the American Heart Association to use statins to prevent cardiovascular disease for some adults with long-term risk kicked off a debate that has not stopped.
Despite support from the US Preventive Services Task Force , some physicians say the harms of statins outweigh the benefits for many patients, and too many patients complain of side effects. Now, a new analysis in the Annals of Internal Medicine supports this viewfor too many patients, authors from the University of Zurich say, the benefits simply dont outweigh the harms.1
The researchers, led by Henock G. Yebyo, MSc, conducted an extensive analysis based on mathematical modeling and concluded the 2013 guidelines should be revised to use much higher 10-year risk thresholds when recommending statins for prevention, and guidelines should be customized based on age, gender, and statin type.
The ACC/AHA guideline called for use of statins for the primary prevention of CVD among adults with a 10-year risk of 7.5% of higher, based on the method of calculating risk contained in the guideline . As this calculator has made its way into practice, there have been adjustments for patient preference and most recently for coronary artery calcium scores to guide decision making.
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Why Are We Still In The Middle Of A Statins War
This article, originally published in 2016, was updated April 3, 2019.
A long-simmering medical debate over a class of drugs used to lower cholesterol burst into the media spotlight across the pond in September 2016. Two British medical journals had accused each other of putting the publics health in danger. British tabloid the Daily Mail called it the statins war.
Nearly three years later, controversy continues to swirl around this often misunderstood but highly effective class of medication.
A study published in the March 2019 Journal of the American Heart Association reported that more than half of patients eligible for statins do not receive them. A majority of those people cited the primary reason as their physicians never offered it.
Thats an amazing figure considering statins are the gold standard when it comes to treating high cholesterol, which we explained in our February 2016 article “10 truths about statins and high cholesterol.”
Data from the 2008 JUPITER Trial suggest a 54 percent heart attack risk reduction and a 48 percent stroke risk reduction in people at risk for heart disease who used statins as preventive medicine.
I dont think anyone doubts statins save lives. So whats the debate? The controversy mainly focuses on two topics:
- Who should receive statins?
- How common and serious are the drugs side effects?
Only 10 percent declined statins, with most citing side effects as their main concern.
Stories About Deciding Whether To Take A Statin To Lower Heart Attack And Stroke Risk
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I’m concerned about my risk of having a heart attack or stroke. So I talked with my doctor about some things that raise my risk, like having diabetes and being overweight. We decided that medicine would be a good idea for me. I’m also going to start getting more exercise and trying to lose some weight.
Becky, age 56
My cholesterol is high, but I really don’t like taking pills. My main risk factor is smoking. My doctor said quitting would help lower my risk. So I’m going to work with him to see if I can finally quit smoking for good.
Diego, age 41
My mom died of a heart attack when she was in her 50s. My doctor calculated my risk, and it is right on the border between moderate and high. But still it worries me because of my mom. My doctor said a statin could help lower my heart attack risk, so I am going to take the medicine.
Charles, age 48
I just had a cholesterol test and found out that my cholesterol is high. But my blood pressure and some other things are fine. I don’t smoke. So my doctor and I talked about it. She said I can try to eat better and get more exercise and see if that lowers my risk.
Carole, age 58
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Why Did My Doctor Prescribe Statins If My Cholesterol Is Normal
Even if your circulating cholesterol is normal according to the numbers onyour blood test results, there may already be plaque present in yourarteries that indicates youre at risk for cardiovascular disease, saysJohns Hopkins cardiologist Michael Blaha. Additional tests may show moreconclusively that plaque build-up is a problem.
Because many factors are involved, your cholesterol numbers may beconsidered normal and yet you may still be found to be at an elevated riskfor heart problems. As a result, statin medications are now used to lowerthe risk of heart disease and heart events in most anyone found to be athigh risk.
The Truth About Statin Use
Statins are one of the most widely prescribed drugs in the world. If you have high cholesterol or are living with heart disease, chances are, you take a statin to help manage those conditions. But how statins work and how they have become one of the best defenses we have in healthcare for preventing heart conditions isnt as commonly understood.
Gerald Koenig, M.D., PhD, an interventional cardiologist at Henry Ford Health, explains what statins are and the cardiovascular benefit of taking them.
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Why Might Your Doctor Recommend Taking A Statin
Your doctor is likely to recommend a statin if you are at high risk of heart attack or stroke. For example, you may be at high risk if you have diabetes and you smoke.
If you are not at high risk of heart attack or stroke, it may not be as clear that you will benefit from taking a statin. You and your doctor may think about certain things, like your family history of coronary artery disease, to decide if medicine may be right for you.
- People at high risk will get more benefit from taking a statin than those at low risk.
- People at low risk will get less benefit from taking a statin. They may decide that a heart-healthy lifestyle is all they need to keep their risk low.