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

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.

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.

Other guideline recommendations

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

“Every 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, population-level effects of statin therapy would certainly be seen. It’s actually been researched, it’s been in use 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 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 advantages.

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 undoubtedly facing a huge wave of cardiovascular disease in our country that will need to be treated with both lifestyle and pharmacological treatments as needed.

What the patient can do

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. It’s not just that,” said Niland. All of these aspects are related to heart health, and statin drugs are one way to reduce risk.”