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How Effective Are Statins At Preventing Heart Attacks

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Statin Myths And Real Heart Attack Prevention

How do statins prevent heart attacks and strokes?

Big Pharma wants you to take statins. Actually, theyd like all older adults to take these controversial, cholesterol-lowering drugs whether or not they need them!

And the American Heart Association and American College of Cardiology both agree. Which makes me wonder, what is wrong with these people?

According to new guidelines, age is the issue, not your heart health. So if youre in your 60s or 70s even if your cholesterol and triglycerides are fine and you have no signs of heart disease dont be surprised if your doctor recommends statins.

The new guidelines apply to white males over the age of 63, white females 71 or older, African American men age 66 or more, or African American women over the age of 70.

Apparently, people in these age groups have a statin deficiency that can only be remedied with expensive pharmaceuticals.

Heres my advice just say No!

Understand I am not against all drugs. But I am opposed to giving patients unnecessary, dangerous medications. And for most people, thats what statins are. Lets look at some of the myths surrounding these drugs and set the record straight.

Key Points To Remember

  • Statins can help prevent coronary artery disease and lower your risk of heart attack and stroke. The benefit is greatest for people at high risk of heart attack and stroke.
  • If you have a low risk of heart attack and stroke, you will get less benefit from taking a statin, so the decision may not be as clear.
  • You can work with your doctor to find out your risk of heart attack and stroke and decide if a statin might be right for you. Your risk is based on your cholesterol levels, your blood pressure, your age and gender, and other things, including whether you smoke.
  • Some people who take statins have side effects.
  • A heart-healthy lifestyle is important to help lower your risk whether you take statins or not. This includes eating healthy foods, being active, staying at a healthy weight, and not smoking.

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Statins are among the few drugs that have consistently been endorsed by distinguished panels of scientists and physicians. The problem is that both doctors and patients have focused on medication while paying too little attention to the remedies that might do much more for cardiovascular health. We know what they are: regular exercise, prudent diet, and not smoking or quitting cigarettes. The most optimistic estimates say that taking a statin could add a year to the average persons life expectancy. Not smoking could add nearly 10 years and quitting increases life expectancy by reducing the chances of emphysema, many cancers, and heart disease.

Although my doctor checks my cholesterol every year, it remains low and taking a statin will have a very small, if any, effect on my life expectancy. Whats worse, my doctor has never asked if I smoke cigarettes, exercise regularly, or eat a healthy diet. Asking the right questions may open opportunities to save more lives. Research shows only about half of current smokers report that their doctor recently recommended that they quit.

Perhaps such indicators are why guidance from the American Heart Association and the American College of Cardiology was recently revised to place much stronger emphasis on lifestyle and social determinants of health

It would be wonderful if a pill could wipe away big threats to our health. But to achieve that goal, we need more than medicine.

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Other Lipids Special Populations And Other Outcomes

Low HDL levels and high triglyercide levels have been identified as secondary treatment targets.7 The combination of a borderline or mildly elevated LDL level and an HDL level of less than 45 mg per dL carries a substantial risk for CHD. Individuals with this lipid combination benefit from statin therapy. In the Air Force Coronary Atherosclerosis Prevention Study ,26 lovastatin was found to reduce CHD events by 0 percent in men with a mean HDL level of 36 mg per dL and in women with a mean HDL level of 40 mg per dL .

Women with diabetes and elevated triglyceride levels are at high risk for premature CHD, as are men with elevated triglyceride levels and low HDL levels. An elevated triglyceride level may be a stronger predictor of recurrent myocardial infarction after coronary artery bypass surgery than an elevated LDL level.27 Much of the benefit from gemfibrozil in the Helsinki Heart Study28 accrued to those with elevated triglyceride levels. Elevated triglyceride levels can be treated with statins, fibrates or niacin. Serious liver problems occur more often with fibrates and niacin.

Do Statins Prevent Heart Attacks And Strokes

Statins prevent 80,000 heart attacks and strokes a year in UK, study ...

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?

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Side Effects Of Statins

Many people who take statins experience no or very few side effects. Others experience some side effects, but these are usually minor, such as diarrhoea, a headache or feeling sick.

Your doctor should discuss the risks and benefits of taking statins if they’re offered to you.

The risks of any side effects also have to be balanced against the benefits of preventing serious problems.

Find out more about the side effects of statins.

The Scoop On Statins: What Do You Need To Know

Why is it important to understand the benefits and risks of statins?

Most heart attacks and strokes are preventable by practicing a healthy lifestyle, and when necessary, taking medications to lower blood pressure or cholesterol or to help quit smoking. Statins, when used as indicated, can dramatically reduce a persons risk of having a heart attack or stroke, but millions of people are missing that opportunity. Some clinicians may miss prescribing a statin to a person who can benefit. Many times, individuals stop or do not start taking a statin due to concerns about side effects. The good news is that understanding your individual benefits and risks and working through your concerns with your clinician can help you prevent heart attacks and strokes and enjoy a longer, healthier life.

What is a statin and how does it work?

Statins are a class of medicines used to lower cholesterol. While some of the cholesterol in your blood comes from food, most is made by the liver. Statins work by reducing the amount of cholesterol made by the liver and helping the liver remove cholesterol that is already in the blood. Statins may also reduce inflammation in the artery walls. This can lead to blockages that damage organs such as the heart and brain.

What are the benefits of statins?

What are the risks of a statin?

How can side effects be managed when taking a statin?

Who should consider taking a statin?

What should I ask my clinician?

Where can I learn more?

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Statin Risks And Benefits

Are statins safe? For most people, the answer is a resounding yes, according to a 2014 Johns Hopkins meta-analysis of 20 years worth of published research. It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. Researchers combed through hundreds of papers that had studied statins since 1994 to determine the evidence of side effects.

Their review, published in British Medical Journal, found an increase in the risk of muscle aches. There was also a modest risk of elevated blood glucose, which can tip some people into developing type 2 diabetes. Whats unclear is whether those people, who also had other risk factors for diabetes, would have developed the condition anyway. Statins dont cause memory loss or cataracts, as has been claimed in the past. For most at-risk patients, the benefits far exceed the risks, the researchers concluded. Of course, if you notice any unusual effects after beginning statin therapy, tell your doctor.

We know a lot about statins because theyve been around for a long time and taken by so many people, Blaha says. The scale clearly tips to benefits in most at-risk patients.

Are Statins Really Worth Taking For High Cholesterol

How do statins prevent heart attacks and strokes?

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Research has shown that statins are highly effective in reducing the risk of fatal heart attack and stroke. But some people are reluctant to take these life-saving drugs. They worry about taking medicine every day for the rest of their life or have heard that statins have undesirable side effects. What does science have to say about these concerns and others surrounding statins? We talked to UH interventional cardiologist Ian Neeland, MD, Director of the Center of Cardiovascular Prevention at University Hospitals, to learn more.

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The West Of Scotland Coronary Prevention Study

The paper is published today in the journal Circulation. It follows on from a five-year 1995 study in which researchers observed the long-term effects of statins on patients involved in the West of Scotland Coronary Prevention Study trial. The researchers took into account the original five-year study and followed the patients for a further 15 years.

This is the strongest evidence yet that statins reduce the risk of heart disease and death in men with high LDL.

Professor Kausik Ray

School of Public Health

The WOSCOPS study provided the first conclusive evidence that treating high LDL in men with pravastatin for five years significantly reduces the risk of heart attack or death from heart disease compared with placebo. Statins were subsequently established as the standard treatment for primary prevention in people with elevated cholesterol levels.

Now, researchers have completed analyses of the 15-year follow up of 5,529 men, including 2,560 with LDL cholesterol above 190 mg/dL of the original 6,595, chosen because they had no evidence of heart disease at the beginning of the present study.

Participants were aged 45-64 years. During the five-year initial trial they were given pravastatin or placebo. Once the trial ended the participants returned to their primary care physicians, and an additional 15-year period of follow-up ensued.

Professor Kausik Ray

School of Public Health

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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Taking Statins For Heart Disease Cuts Risk In Half Yet Only 6 Percent Of Patients Taking As Directed

Date:
Intermountain Medical Center
Summary:
A new study finds that taking statins for heart disease cuts risk of second serious event in half, yet only 6 percent of patients are following as directed.

A new study has found that patients with atherosclerotic cardiovascular disease cut their risk of a second major adverse cardiovascular event by almost 50 percent, if they adhere to taking a statin medication as prescribed by their doctors.

While that’s good news for patients, the bad news, however, is that researchers from the Intermountain Healthcare Heart Institute in Salt Lake City found that only about six percent of patients are in fact following the statin regimen given to them to lower their cholesterol, negating any potential cardiovascular benefits.

“A lot of clinical trials have shown that statins reduce the risk of secondary outcomes, so it’s really important that they take these medications,” said the study’s principal investigator, Heidi May, PhD, principal investigator of the study, and cardiovascular epidemiologist at the Intermountain Healthcare Heart Institute. “The surprising thing that we found is that so few patients, even within an insured population, just didn’t take their statin medication as prescribed.”

Results of the study were presented on March 16 at the American College of Cardiology Scientific Sessions in New Orleans.

Dr. May believes the importance of taking statins could be lost in the abundance of information patients are given at discharge.

Lifestyle Changes To Benefits Your Heart Health

Should you take statins? Guidelines differ

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:

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Study Selection And Validity Assessment

We included parallel-group randomized controlled trials if they included people 16 years or older who were at low cardiovascular risk , the follow-up period was at least six months, and an eligible statin was compared with no statin . We categorized statins according to their pharmacologic effect on lowering cholesterol as either low potency or high potency .8 To be eligible, studies also had to report one or more of the following outcomes: all-cause mortality, unstable angina, acute myocardial infarction , stroke or transient ischemic attack , surgical or percutaneous revascularization, length of stay, quality of life, persistence on statin therapy, and adverse events. Trials with fewer than 30 participants per study arm were excluded to improve the efficiency of the work without an appreciable loss of power.9

Trials were considered to have enrolled participants at low cardiovascular risk if the 10-year risk of cardiovascular-related death or nonfatal myocardial infarction among participants was less than 20%,10 as assessed by extrapolation of observed risk in the control group of each trial. In general, this corresponded to participants who were free from cardiovascular disease and diabetes. Data from trials in which some, but not all, participants had known cardiovascular disease were included if the control group had a low cardiovascular risk .

American Heart Association News Stories

American Heart Association News covers heart disease, stroke and related health issues. Not all views expressed in American Heart Association News stories reflect the official position of the American Heart Association. Statements, conclusions, accuracy and reliability of studies published in American Heart Association scientific journals or presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the American Heart Associations official guidance, policies or positions.

Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. Permission is granted, at no cost and without need for further request, for individuals, media outlets, and non-commercial education and awareness efforts to link to, quote, excerpt or reprint from these stories in any medium as long as no text is altered and proper attribution is made to American Heart Association News.

Other uses, including educational products or services sold for profit, must comply with the American Heart Associations Copyright Permission Guidelines. See full terms of use. These stories may not be used to promote or endorse a commercial product or service.

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Subgroup And Sensitivity Analyses

Indirect comparisons between high- and low-potency statins did not show a significant difference in the risk of all-cause mortality , fatal or nonfatal myocardial infarction or stroke .

The sensitivity analyses, many of which used alternative definitions of low cardiovascular risk, showed findings that were consistent with the results of the primary analysis across a wide variety of assumptions and conditions . In particular, use of estimates rather than observed data to classify trials with respect to 10-year cardiovascular risk led to similar conclusions regarding the efficacy of statins in reducing all-cause mortality. In addition, when low cardiovascular risk was defined as a 10-year risk of cardiovascular-related death or nonfatal myocardial infarction of less than 10%, the pooled relative risk was similar to that of the primary analysis . The pooled relative risk of all-cause mortality among statin recipients was statistically significant in virtually all of the sensitivity analyses . In addition, the point estimate for the pooled relative risk was relatively stable in these analyses , except for one analysis that included trials with a follow-up period shorter than the median of two years .

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