Posted on 11/13/2013 9:16:32 AM PST by Armen Hareyan
For years doctors have been focused on specific cholesterol numbers to help patients prevent initial and recurrent heart attack. New guidelines mean only those at high risk will be recommended to take the drugs. So how will doctors decide who is at high risk? More importantly what are physicians already saying about changes?
Dr. Neil Stone of Northwestern University chaired the committee that wrote the new guidelines, which was a collaborative effort between the American Heart Association and the American College of Cardiology.
No more statins to control cholesterol numbers say experts
Instead of looking at cholesterol numbers Stone said physicians should prescribe statins based on who will really benefit the most.
What that means is you may not need your statin unless you’ve had a heart attack, are diabetic and age 40 to 75 or if your LDL (bad) cholesterol is 190 or higher. In the past anti-cholesterol drugs were recommended for LDL cholesterol 130 or higher, but 70 or lower for anyone who had already had a heart attack.
There are also other risk factors for heart attack your physician will take into consideration. Examples might include strong family history of heart disease or very high triglyceride levels.
One of the biggest changes if for people with diabetes who were always recommended to take a statin drugs that for some can cause aching muscle and even muscle damage. Younger diabetics may not need the drugs.
The new recommendations also could mean bigger profits for pharmaceutical companies.
Estimates are that the number of people taking statin drugs could double. The reason is because it isn't about numbers anymore. Instead, the drugs are suggested based on a new algorithm.
For instance, a very recent study shows people who are metabolically healthy are still at risk for heart attack. It could be physicians will recommend more of the anti-cholesterol drugs based on body mass index.
So now, people with no signs of heart disease and without high cholesterol are being targeted for the drugs.
Race, gender, age, high blood pressure and family history are all tools doctors are now being asked to use to determine if a patient needs to take a cholesterol lowering drug.
If your risk for stroke or heart attack within the next 10 years turns out to be 7.5 percent or higher you may be receiving a cholesterol lowing drug recommendation from your doctor.
Why the change?
One reason is that statins don’t really help people reach the cholesterol targets that doctors have been treating for decades. So why keep giving them when they don’t work to control numbers. The panel felt an updated algorithm was needed.
Also, even though statin use might increase – depending on how well the guidelines are accepted by physicians – they’re not without side effects. And doctors know that.
Twenty to 30 percent of people who take the drugs suffer from muscle damage. Liver damage is another side-effect of the medications that requires regular blood work and close watching. Some patients have memory problems from cholesterol lowering drugs. All of the side effects might outweigh the benefits of a patient’s 10-year risk of heart attack who falls outside of the new guidelines.
If you have never been diagnosed with heart disease for instance, you could lower your chances of having one by 0.4 percent. But patients who have had heart complications would lower their heart risks a little more than one-percent, as would diabetics.
Some concerns
Dr. Paul Ridker who is a cardiologist at Brigham and Women’s Hospital said “A 55-year-old male smoker with high blood pressure would be deemed at high risk, but he should be told to stop smoking and given blood pressure drugs, not a statin.”
I would agree – but another approach might be if a 55-year old male smoker doesn't make the lifestyle change then maybe a statin drug should be prescribed for cardioprotection. It ends up a patient/physician decision.
But that leads to another expressed concern from doctors that patients will take cholesterol drugs rather than make lifestyle changes. Also without specific cholesterol level goals, would people just start eating whatever they want?
Other heart specialists feel inflammation should be more the focus in determining who is at risk for heart attack and stroke. A simple blood test that measures CRP or C-reactive protein can gauge inflammation in the body and has been suggested as an adjunct for predicting who is at risk for heart disease by Dr. Ridker.
You can lower inflammation in the body by eating anti-inflammatory foods and cooking with herbs and spices like turmeric and rosemary. Omega-3 fatty acids are also important. One of the reasons people take aspirin to prevent stroke and heart attack is because it quells inflammation.
The Mediterranean diet is shown repeatedly to be linked to lower incidence of heart disease for those who focus on the main ingredients in the diet - fish, olive oil; perhaps some red wine.
Dr. Andrew Weil and Dr. Barry Sears of the Zone diet have been proponents of consuming anti-inflammatory foods to keep blood vessels healthy. Dr. Dean Ornish, a pioneer in reversing heart disease also focuses on diet and lifestyle including controlling stress with exercise, diet, yoga and meditation to lower our heart risks.
What else besides drugs is recommended for heart protection?
We also have new guidelines from the same panel on how to lower your LDL cholesterol and stay heart attack and stroke free.
Even if your doctor recommends a statin for you here are other steps you also need to take:
The new guidelines expand who should receive cholesterol lowering drugs known as statins and removes focus from cholesterol numbers. Some physicians are already expressing concern about the changes. We also have nutrition and activity guidelines that the expert panel says should be embraced by any physician concerned about heart attack prevention.
Related: Can you name statin side effects? Evidence lacking that anti-cholesterol drugs lower heart attack risk 11 ways to lower your heart attack risk
Updated November 13, 2013
I am unable to take statins, which my internist realized when I experienced a bad reaction from every kind, including natural statins such as red yeast rice.
But he also told me there was no real proof that statins were beneficial anyway.
Statins have multiple protective effects apart from cholesterol lowering. Anti-inflammatory, plaque stabilizing and even antineoplastic effects to name a few.
I’ve read the fine print on statins. They destroy your liver.
No thanks.
I keep my cholesterol more-or-less in control with lots of structured exercise (cardio and weights) and drinking plenty of water.
I suggest developing something to go along the artery walls like scrubbing bubbles and eat all of the deposits.
Some livers are more durable than others. I’d factor family history into deciding whether or not to use statins, or alcohol, or acetaminophen , etc. If your family has no liver troubles, then go for it!
btw - my cholesterol is borderline....
Not up to doctors. Up to ‘Madame Secretary’ the the IPAB...
After 6 weeks of eating nothing but canned food and white rice in the North Dakota oil field I had a physical and the doc put me on a cholesterol lowering statin drug. After a few weeks I could barely lift my right arm from the muscle pain. I won’t take it any more. Not worth it. I know that when I’m home my wife makes healthy food from our garden most of the year and if I’ve had a good year hunting we eat mostly lean wild meat and fish.
” New guidelines “ = DEATH PANELS
Why does everyone think we want to live to 100?? There's too many stories that say....leave me alone.
Spudville, the side effects of statins can be genetically initiated. You may be a slow metabolizer that causes your body to slowly convert the drug to an inactive form. This allows the blood level to exceed the therapeutic range, leading to side effects. The opposite can happen with fast metabolizers, resulting in sub-therapeutic levels. Likely you would be OK with a lower dose or an alternate statin. Lots of research being done on this in medical schools that have interest in personalized medicine.
A five mile walk, a half an aspirin and a clove of live garlic every day. I`m tellin` ya.
> ’d factor family history into deciding whether or not to
> use statins, or alcohol, or acetaminophen , etc. If your
> family has no liver troubles, then go for it!
I don’t drink alcoholic beverages.
And I don’t take acetaminophen every day, as I would have to take statins.
Family doesn’t have any history with liver that I know of, but, then again, my parents were immigrants from a relatively primitive society (no doctors), so I would not know beyond my immediate parentage.
I prefer not to stress my liver if I can just exercise and drink the recommended 8 glasses of water per day.
Much of the adverse cognitive changes have been anecdotal. A number of studies show that statins may actually prevent dementia.
- info on dangers os statins been out there for years - which is why I refused to take them after my heart attack, and resultant CHF, almost 20 years ago.
ALL I take is enalopril
Ditto my son
docs can’t figure out why we’re so much healthier than expected =
(I also take hawthorne, magnesium and niacin)
You can add my anecdote. I quit taking a statin because we were traveling and I didn't make the effort to keep taking them. When we returned home I simply didn't start taking them again. Within a few months I noticed that my intellectual curiosity was greatly increased. I began pursuing technical hobbies which I had previously abandoned.
Perhaps just a coincidence? I'll wait until there is strong evidence that there is not a connection.
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