Latest statin guidance maintains more conservative approach to preventing first stroke or heart attack

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The U.S. Preventive Services Task Force released updated guidelines on Tuesday regarding the use of statins to prevent a first heart attack or stroke. The recommendations are virtually unchanged from previous guidance, but are now supported by additional research, the group said.

The recommendations are a little more conservative than the guidelines published by the American College of Cardiology and the American Heart Association, and some doctors are wondering if they should be more aggressive.

Heart disease is the number one cause of death for men and women worldwide. Every 34 seconds she dies from cardiovascular disease in the US. According to the US Centers for Disease Control and Prevention.

Specifically, published USPSTF guidance JAMA on Tuesday Statins are recommended for adults aged 40 to 75 who have one or more risk factors for cardiovascular disease and a 10% or greater risk of having a heart attack or stroke in the next 10 years. These risk factors include diabetes, high blood pressure, smoking and high cholesterol. To calculate a person’s risk score, doctors also consider factors such as a person’s age, gender, race, blood pressure, cholesterol levels, and family history.

Current guidance recommends that people with a slightly lower risk of having a heart attack or stroke over the next 10 years of 7.5% to 10% consult their doctor before deciding whether to take a statin. increase.

The risk is slightly lower in this group, so there is some benefit, but less benefit. In this case, patients should consult their physicians to determine whether or not they should be taken based on individual factors. There are other individual-level factors that health professionals and patients can work together to decide what is best for them,” said Jong Wong, M.D., professor of medicine at Tufts University. That includes things like diet and exercise.

For adults over the age of 76, there was not enough research to recommend taking statins for the first time.

The USPSTF last updated its statin guidelines in 2016. Since then, there have been several new studies determining the effectiveness of statins, Wong said.

In short, 40 years of science have shown that statins are safe and an excellent primary preventive measure that can reduce your risk of developing heart disease and dying.

To make these recommendations, the USPSTF reviewed 26 studies to compare outcomes in people who took statins and those who didn’t. In the study he participated in more than 500,000 patients.

“Statins were significantly associated with a lower risk of all-cause mortality,” the study said. This was true for all demographics.

Based on these studies, the risks of taking statins seemed small. With the exception of one study involving therapy, these latest studies used to create these guidelines did not represent reality.Both problems are on the rise, according to experts.

An editorial accompanying JAMA’s recommendations suggested that these guidelines should be more aggressive and more compatible with cholesterol. guidelines Recommended by the American College of Cardiology and the American Heart Association. These guidelines recommend statins for adults aged 40 to 75 who have a greater than 7.5% risk of developing a heart attack or stroke over the next 10 years, not 10% for him. ACC/AHA guidelines also recommend statins for diabetics and statins for patients with very high cholesterol levels without having to calculate a person’s 10-year risk score.

“People with higher baseline risk see greater absolute benefit from intervention than those with lower risk. When statins are dangerous or expensive, such tailored treatment strategies are reasonable. However, Statins are now available as generic drugs, safe and affordable,” wrote a doctor at the University of Texas Southwestern Medical Center in Dallas in an editorial.

Dr. Edward Fry ACC Chairmanit is important to note that the USPSTF guidelines are statements that apply to a broad group or patient population, whereas the ACC/AHA guidelines are more individualized. neither will it be done.

“Any medical decision must be made in an individual context, and these guidelines provide a kind of roadmap. There may be several different routes to get where you want to go, but this It’s a roadmap,” Fry said. “The differences between the guidelines are relatively small.”

For example, one area not covered by the USPSTF guidelines is coronary artery calcium scores in humans. A heart scan can look for calcium in the coronary arteries. Calcium and plaque are related. For patients bordering on high or intermediate risk, the score can be used as another determinant.

Other factors that the ACC/AHA guidelines take into account that are not part of the USPSTF calculation, what physicians call “risk enhancers,” may also help with decisions about these borderline cases. For example, a 35-year-old with a family history of heart disease and high cholesterol is not included in these guidelines, but may be a good candidate for a statin. Section of Cardiovascular Research at Baylor College of Medicine.

“Risk enhancers may increase a patient’s short-term 10-year risk, or possibly lifetime risk of having a cardiovascular event, and these guidelines suggest that clinicians should err on the side of early treatment. recommended by the U.S. Preventive Services Task Force,” Virani said. “But I would like to emphasize that even if clinicians adopted the more conservative U.S. Preventive Services Task Force recommendations and followed them very aggressively, statin therapy would ensure a population-level impact. It’s been studied for a very long time and now we know it works.”

Dr. Ian Neeland, a cardiologist at the University Hospitals Harrington Heart & Vascular Institute and director of the UH Center for Cardiovascular Prevention, is not involved in either guideline, but another big takeaway from the USPSTF is: It says it’s a “reaffirmation” of previous guidelines. The guidelines and the science they use clearly show that statins are safe.

“Overall, the serious risk of serious adverse events is very low, so the risk-benefit for at-risk individuals usually favors statins,” Kneeland said.

“Statins are very useful in long-term risk reduction, have very few side effects, and have great benefits.

He also said it was important to keep in mind that guidelines are just guidelines. “They need to be used in a clinical context and within the art and science of medicine,” Kneeland said.

Virani said more must be done to prevent heart problems.

“We are definitely facing a huge wave of cardiovascular disease in our country that will need to be treated with both lifestyle therapy and medication as needed,” Virani said.

Virani said it’s important for patients to ask their providers their 10-year risk of heart attack or stroke. It is a calculation that requires expert knowledge and cannot be done alone.

“Having this conversation doesn’t mean you need to get therapy, but it will lead to many important discussions related to your lifestyle.

Of course, statins aren’t the only drugs that can help prevent heart attacks and strokes.

Both the USPSTF and ACC/AHA recommend that patients reduce their risk by quitting smoking, exercising, and eating healthily.

“Statins are part of the prevention wheel. They’re not the only works,” Kneeland said. “Diet, physical activity, maintaining a healthy weight, controlling blood pressure, and ensuring diabetes and the risk of diabetes are under control. All of these aspects affect heart health. It’s one of his ways to do it.”