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New Studies: More Americans Would Benefit From Taking Statins to Lower Heart Disease Risk

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August 28, 2015

If you are due for a health checkup and high cholesterol screening, you may want to talk to your healthcare provider about your personal risk for heart disease during your next visit. Two new studies published recently in the Journal of the American Medical Association (JAMA) support guidelines released two years ago by the American Heart Association and the American College of Cardiology (AHA/AAC) that included a new approach for evaluating heart disease risk. These new recommendations would result in more people taking statins to lower cholesterol and prevent heart disease and strokes.

The 2013 AHA/ACC guidelines were the first ones on cardiovascular disease (CVD) risk since guidelines known as the Adult Treatment Panel (ATP) III were updated in 2004 by the National Cholesterol Education Program of the National Institutes of Health (NIH). (Read "Experts Announce Major Updates to Guidelines for Heart Disease Risk Assessment and Prevention.") The ATP III guidelines focused on low-density lipoproteins (LDL or "bad cholesterol") levels to decide who should be prescribed statins and recommended using treatment to lower LDL to optimal target levels.

In contrast, the AHA/ACC guidelines also consider other risk factors, such as age, gender, weight, blood pressure, and whether a person is a smoker, to decide whether treatment is warranted. The decision to treat is based on a new risk calculator to determine an individual's risk of having a heart attack or stroke in the next 10 years. A person with a 7.5% or higher risk should be prescribed statins, regardless of their LDL numbers, according to the AHA/AAC guidelines.

Not all health practitioners have agreed there is a need to switch to the 2013 guidelines. Criticism of the guidelines includes the concern that the online calculator overestimates the risk and that the new guidelines may expose many patients to the risk of side effects from statins, such as severe muscle pain and a rare risk of liver damage.

The recent ACC/AHA guidelines have not resulted in many more prescriptions for the statin drugs, according to a recent article in the New York Times. However, results from the JAMA studies may provide more evidence for health practitioners and prompt them to reconsider the new guidelines and prescribe statins for more patients who qualify under the new recommendations.

Both JAMA studies comparing the two guidances were funded by the NIH. The first study analyzed data on 2,400 people in the Framingham Heart Study, a decades' long study that looked at causes and prevention for heart disease, who did not take statins. The researchers found that the AHA/ACC guidelines are more effective than ATP III in identifying people who have increased risk of heart disease. The data suggested that roughly 41,000 to 63,000 cardiovascular events, such as heart attacks and strokes, could be prevented over a period of 10 years by applying the new guidelines instead of ATP III.

The second JAMA study looked at cost effectiveness and found that although there would be a cost associated with giving statins to more people, the benefits of fewer heart attacks and strokes would more than outweigh that cost. An editorial in the same issue of JAMA said that "the available evidence indicates that statins are both effective and cost-effective for primary prevention…"

Given the change in guidelines and evidence from these studies, it is important for people to have a conversation with their healthcare providers about what is best for them. New England Journal of Medicine Journal Watch Cardiology editor-in-chief Harlan Krumholz commented that, "These studies further support the wisdom of transitioning the guidelines from a focus on cholesterol levels to the level of the patient's risk. It is also important to remember that the guidelines are broad recommendations and each decision depends on the preferences of each individual patient."

Though the AHA/ACC guidelines may prompt changes for treatment of CVD risk, cholesterol screening practices remain the same. "Neither of the [JAMA] articles would change the minimal frequency of checking a [lipid] profile in individuals which is every 5 years," says Donald Smith, MD, an associate professor of cardiology at Mount Sinai Hospital in New York City. However, treatment for high cholesterol may alter the frequency of testing.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

Philip Greenland, Michael S. Lauer. Cholesterol Lowering in 2015. Still Answering Questions About How and in Whom. JAMA, Vol. 314, No. 2 (14 July 2015). Available online at http://jama.jamanetwork.com/article.aspx?articleid=2396463 through http://jama.jamanetwork.com. Accessed August 3, 2015.

Amit Pursnani, et al. Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events. JAMA, Vol. 314, No. 2 (14 July 2015). Available online at http://jama.jamanetwork.com/article.aspx?articleid=2396478 through http://jama.jamanetwork.com. Accessed August 3, 2015.

Ankur Pandya, et al. Cost-effectiveness of 10-Year Risk Thresholds for Initiation of Statin Therapy for Primary Prevention of Cardiovascular Disease JAMA, Vol. 314 No. 2 (14 July 2015) Available online at http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=934228&direction=P through http://jama.jamanetwork.com. Accessed August 3, 2015.

Andrew Pollack. 2 Studies Back Guidelines for Wider Use of Statins. New York Times, July 14, 2015. Available online at http://www.nytimes.com/2015/07/15/health/broader-statin-use-gets-support-from-2-new-studies.html through http://www.nytimescom. Accessed August 3, 2015.

July 24, 2015. FDA approves Praluent to treat certain patients with high cholesterol. Available online at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm455883.htm through http://www.fda.gov. Accessed August 3, 2015.

Email interview with Donald Smith, associate professor, Mount Sinai Hospital in New York City.

Andrew Pollack. July 24, 2015. New Drug Sharply Lowers Cholesterol, but It's Costly. New York Times. Available online at http://www.nytimes.com/2015/07/25/business/us-approves-drug-that-can-sharply-lower-cholesterol-levels.html through http://www.nytimes.com. Accessed August 11, 2015.

(July 15, 2015) Cara Adler. ACC/AHA Cholesterol Guidelines Found Efficient and Cost-Effective. JournalWatch. Available online at http://www.jwatch.org/fw110411/2015/07/15/acc-aha-cholesterol-guidelines-found-efficient-and-cost?query=pfwRS through http://www.jwatch.org. Accessed August 20, 2015.

(Jul 29, 2015) Tim Casey. Studies show superiority of ACC/AHA guidelines for managing blood cholesterol. Cardiovascular Business. Available online at http://www.cardiovascularbusiness.com/topics/practice-management/studies-show-superiority-accaha-guidelines-managing-blood-cholesterol through http://www.cardiovascularbusiness.com. Accessed August 20, 2015.