Sharyn Saftler, Arivale Coach, Registered Dietitian Nutritionist
It’s widely recognized that statin medications can be effective at reducing the risk of heart disease. As a result, national and expert guidelines recommend statin use for at-risk populations. A new study, however, questions whether these guidelines adequately balance the risks of statins versus their benefits.
Currently, the US Preventative Services Task Force guidelines recommend doctors prescribe statins to prevent cardiovascular disease (CVD) mortality and events, such as heart attacks and strokes, in adults between the ages of 40 and 75 if they have one or more CVD risk factors (high cholesterol, diabetes, high blood pressure or smoking) and a calculated 10-year risk of a CVD event of 7.5 percent or greater.
Although the American College of Cardiology recently updated their guidelines to allow for more personalization, physicians have widely adopted the prior guidelines which, if fully implemented, would mean up to 40 percent of Americans would be taking statins.
The new study published this month in the Annals of Internal Medicine was a meta-analysis of previous clinical trials of low- or moderate-dose statins compared to placebo. As described in an NPR report, the findings showed fewer people are likely to benefit from statins than the current guidelines suggest.
Specifically, older individuals got less benefit relative to harm than younger ones. For example, men between the ages of 40 and 44 saw statin benefits with a CVD risk score of 14 percent while men over 70 didn’t benefit until their CVD risk was 21 percent. Similar results were seen for women. And different statins had different benefits, with Atorvastatin (Lipitor) and rosuvastatin (Crestor) performing the best.
While the current guidelines did consider the potential risks of statins, the study authors noted that it’s unclear to what extent these played into the final recommendations. Low- to moderate-dose statins, which the guidelines recommend, are typically safe. However, adverse effects that have been associated with statins include increased diabetes risk, muscle pain, and cataracts. Some studies have suggested potential increased risk for cognitive decline and dementia, but this is not supported by systematic reviews.
This study highlights a principle that is foundational to Arivale’s approach: personalization matters! This is not only true for lifestyle and behavioral changes but clearly for medical approaches, such as drugs. As one of the study authors states in the NPR story: “One size doesn’t fit all. That’s a very important message.”
Another key principle is that it’s important to understand whether you may have increased risk for a certain condition so you can be proactive in addressing risk factors. Anyone can use the Heart Risk Calculator to determine their risk for heart disease and take this information to their doctor for a discussion of options to reduce risk if needed.
Of course, lifestyle change is foundational to reducing CVD risk. The American Heart Association’s “Simple 7” steps define the plan:
- Be physically active
- Control cholesterol
- Eat better
- Manage blood pressure
- Lose weight if needed
- Reduce blood sugar
- Stop smoking
While these changes may be “simple,” we all know they’re not easy! Most of us need some support to change ingrained habits and behaviors. But with steady, small changes in behavior and a good support system, modifying lifestyle to reduce CVD risk is possible.
- At Low Risk for Heart Disease? It Still Pays to Watch Your Cholesterol
- Is This Really the Ideal Amount of Exercise to Keep a Healthy Heart?
- Eating an Egg a Day May Actually Be Good for Your Heart
[Arivale Hot Topics address health stories currently in the news. The Arivale Clinical Team’s commentary on these news articles is not a review of the scientific evidence, nor an endorsement of a specific study, and is not meant as official medical opinion.]