Should Statins Be Given To More People?

Statins, which include Lipitor, Mevacor, Crestor and Zocor, are the most widely prescribed cholesterol-lowering medications in the world. About 15 percent of American adults are taking them at a cost ranging from about $4 per month for the cheapest generic version to $600 for a pricey name-brand.

Old guidelines advised people to aim for a total cholesterol level of less than 200, keeping LDL (bad) cholesterol to 130 for average people and under 100 for those considered at risk of a heart attack. In 2013, new guidelines from the American Heart Association and the American College of Cardiology recommended that statins should be given to anyone with a 7.5 percent risk or higher of developing heart disease over the next 10 years. Adopting the new guidelines also means that between 8 and 13 million more people would be prescribed with statins.

Experts fear that the new guidelines would put too many Americans to statins’ risks without compensating benefits. Statins do have side effects. They can damage muscle in 5 to 15 percent of patients. In 2012, the Food and Drug Administration (FDA) updated labeling on statins to include warnings about confusion and memory loss, elevated blood sugar leading to Type 2 diabetes, and muscle weakness. Many patients and doctors are also complaining that the new guidelines are confusing.

But 2 recently released papers concluded that the new guidelines might prevent tens of thousands of heart disease, stroke and death, and they are cost effective, too. Both papers were published July 14, 2015 in the ‘Journal of the American Medical Association’

In one paper, researchers at Harvard School of Public Health proposed a formula that considers age, weight, blood pressure and other factors like whether patients smoke or have diabetes, to predict whether they have at least a 7.5 percent chance of having a heart attack or stroke in the next 10 years. Using the formula, the researchers estimated that between 41,000 and 63,000 heart attack, stroke or death could be prevented in the over a 10-year period. They further pointed out that if statins were given to people with a 3 percent risk of developing heart disease over 10 years, another 160,000 heart attacks and strokes would be prevented.

Another paper, which was conducted by researchers from Harvard-affiliated Massachusetts General Hospital and other institutes, revealed that the 7.5 percent risk for cardiovascular events is a cost-effective threshold using standard cost and longevity measures. They also proposed that people with even a 3 percent or 4 percent risk of suffering heart attacks or strokes could be put on statins cost-effectively.