The studies support the wider use of statins for lowering cholesterol

The latest guidelines used to determine who should take statins to lower cholesterol to prevent heart disease appear to be more accurate and cost-effective than previous guidelines. This is according to two studies by Harvard researchers, both published this week in the Journal of the American Medical Association.

For many years, the main determining factor in who needed to take a statin cholesterol was a harmful low-density lipoprotein person (LDL). Updated guidelines issued in 2013 by the American College of Cardiology and the American Heart Association LDL removed and recommend instead a statin for men and women between the ages of 40 and 75 who have a 7- 5% or more at risk having a heart attack or stroke over the next 10 years. (You can use this online calculator to calculate your risk, you will need your total cholesterol and HDL cholesterol and the values ​​of blood pressure.) Statins are commonly prescribed atorvastatin (Lipitor) and simvastatin (Zocor).  

Shortly after the new guidelines were released, two Harvard experts argued that went too far, citing concerns that the calculator often overestimated the risk of having a heart attack or stroke. Paul Ridker cardiologist and epidemiologist Nancy Cook, makes the case that, following the new guidelines, many healthy people end up taking a statin but get few benefits of the drug while the risk of side effects such as pain muscle and tracks diabetes.

The two JAMA studies have attempted to address these concerns by comparing the new guidelines with the elderly. Although older guidelines focused primarily on reducing the harmful LDL cholesterol in a person, the new guidelines have a broader vision, which is to the age, sex of a person, weight, blood pressure and snuff consumption, in addition to cholesterol.

One of the JAMA study looked at 2,435 people in the long-term Framingham Heart Study who were not taking a statin. Lead author Dr. Udo Hoffmann, professor of radiology at Harvard-affiliated Massachusetts General Hospital and colleagues found that 39% of study participants would have been eligible to take statins under the new guidelines compared to 14% according to most guidelines. 
 
Then they looked at the number of heart attacks, strokes and cardiovascular deaths in both groups over a period of nearly 10 years. The rates in the two groups were almost the same (a little over 6%), suggesting that the new guidelines would not put too many people on drugs unnecessarily. And when they looked for people who were not entitled to a statin under the new guidelines, only 1% had a heart attack or stroke. In the old, 2.4% did. This suggests that the new guidelines provide a more accurate assessment would benefit from a statin and who would not.

"We will dial for a more accurate prediction of the risk of heart disease and its relevance to statin therapy," says co-author Dr. Christopher O'Donnell, chief of cardiology at the VA health system Boston and associate professor at the Medical School of Harvard University. 

Another JAMA study was based on a computer model to calculate the cost-effectiveness of the new guidelines. Model projects costs for a hypothetical group of Americans between the ages of 40 and 75 who take a statin based on the new guidelines. These costs include the costs of visits cholesterol tests, medications, laboratory and medical as well as the cost of treating heart attacks and strokes, said lead author Dr. Thomas A. Gaziano, associate professor Health policy and management and a cardiologist at Brigham and Women's Hospital. The disadvantages of taking a statin, including the disadvantage of taking a pill every day and a slightly higher risk of diabetes associated with statin use were also part of the equation. Another key factor in the model was a measure called adjusted life year on quality, which measures the burden of disease in terms of quality and quantity of life lived.

The model showed that the new guidelines - which would be almost half of adults 40 to 75 years on a statin - be profitable. In fact, the model predicts that lowering the threshold for prescribing statins risk down 7.5% at 10 years to a 3% risk to ten years would save even more money. In this scenario, about two-thirds of adults between the ages of 40 and 75 would take a statin.

An explanation of the results: Most statins are now available in generic form, so that the annual cost of the catch was reduced from several thousand dollars per year to about $ 100 per year.

If all this have to wonder if you should take a statin - especially if your risk is about 7.5% or less - this is another way to think about the decision. Statins reduce the risk of heart attack by 20%. "If you are in a low-risk group, say 5%, taking a statin reduces the risk to 4%," says Dr. Gaziano. Some people in the group may decide it's not worth taking any medications day for a small profit. But others might want to do everything possible to reduce the risk, he said. Therefore, it is very important to have a discussion with your doctor about your own situation and preferences.

Finally, do not overlook other important aspects to reduce the risk of heart disease. "The World Health Organization says that almost 80% of all heart disease could be prevented through lifestyle changes," says Dr. John Abramson, a professor of health policy at Harvard Medical School. This means eating a healthier diet, regular exercise and not smoking. "Statins are the most widely used class of prescription medicines in the world's history, but has never been a study comparing lifestyle changes," says Dr. Abramson.