The Statin Debate

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The American Heart Association and the American College of Cardiology (AHA/ACC) recently released new cardiovascular prevention guidelines that have some medical professionals up in arms, particularly concerning the use of cholesterol-lowering statins. According to the authors, the guidelines are based upon the best available scientific data. In short, the new lipid lowering guidelines move away from statin treatment based solely upon targeted levels of LDL (bad cholesterol), HDL (good cholesterol) and triglycerides. Instead, the AHA/ACC recommend statin therapy for the following groups:

  • Those with confirmed heart disease
  • Those with LDL levels greater than 190
  • People ages 40-75 who have diabetes
  • People with a 10-year risk of heart disease greater than 7.5 percent, based upon a new risk assessment calculator that uses an equation to determine risk based upon race, gender, age, total cholesterol, HDL cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status.

Although many who have confirmed heart disease, high LDL levels and diabetes are already using statins, adding the final group (those with a 10-year risk of heart disease greater than 7.5 percent), would amount to about 31 million people in all. That means a full one third of America’s population between the ages of 40-65 are being placed on statins, said John Higgins, MD, a sports cardiologist at the University of Texas Health Science Center at Houston. This is not entirely agreeable to him. “For people with confirmed atherosclerotic cardiovascular disease, statins appear to be very beneficial,” he said. “But for those who do not have diagnosed coronary disease, it is a little more difficult to put some of these on a medication for life that is expensive and that has significant side effects.”

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Amy L. Doneen, ARNP, medical director of the Heart Attack and Stroke Prevention Center in Spokane, Washington, and co-author of soon to be released book, Beat The Heart Attack Gene, agrees that the guidelines may miss the mark, stating that there are many root causes of vascular disease that statin therapy won’t help. She said some people who have high cholesterol but not vascular disease or vascular inflammation may be treated needlessly. “We use statin therapy for individuals who have plaque in their arteries, not simply because someone has high LDL levels, because it is one of the best drug classes to treat vascular inflammation,” she said. “These guidelines have the potential to place many people on moderate to high dose statin therapy who don’t have arterial plaque and contrarily, miss many of the root causes of vascular disease that cannot be treated with isolated statin therapy.”

According to the AHA, the new cardiovascular prevention guidelines are simply a tool to encourage those who may be at high risk for heart disease to discuss the risks and benefits of statins with their physician. Which is a good plan, said Dr. Higgins, because statins, like any drugs, have side effects that may be uncomfortable. And for athletes, he added, “statins may impair the exercise training effect on maximal oxygen capacity and muscle adaptations.”

While you may ultimately need a statin, said Dr. Higgins, “exercise, diet and avoiding unhealthy habits are still my first line treatment for many. If we could do a better job with lifestyle changes, we could cut down on the use of statins.”

By Linda Hepler, BSN, RN