Each year, about one in four Americans over the age of 45 are prescribed cholesterol-reducing drugs known as statins. Statins are widely used to help reduce the risk of stroke, heart attack, and death by heart disease. Some studies have shown that statins can reduce the chances of recurrent heart attack or stroke by up to 40 percent. However, new guidelines released late last year by the American Heart Association and the American College of Cardiology suggest that nearly twice as many Americans should consider taking statins as part of their daily pill-popping regime. The new statin guidelines suggest that about 33 million Americans (about 44 percent of men and 22 percent of women) would meet the new threshold requirements for statin use, representing a large shift in how doctors could view statin prescription and leaving some health experts very concerned.
Statins work their magic by blocking the substance bodies need to create cholesterol while also helping bodies reabsorb cholesterol that has built up in arterial walls. However, the new guidelines move far beyond the borders of traditional cholesterol-lowering tactics to include treatment recommendations for people who may not have an issue with high cholesterol at all. The guidelines offer doctors a new way to calculate a person’s risk factors for heart attack and stroke and include elements besides high cholesterol levels, such as age, ethnicity, gender, and certain high-risk behaviors (like smoking).
According to an article released by NBC, the American Heart Association’s new principles recommend moderate to high statin therapy for about one-third of all adults. The guidelines now include people with a history of cardiovascular disease, stroke, or heart disease, folks between the ages of 40 and 75 who have type 1 or type 2 diabetes, those in the same age range who show a ten-year risk of heart attack or stroke that is 7.5 percent or higher, and those over the age of 21 with LDL (“bad cholesterol”) levels of 190 or above.
American Heart Association president Mariell Jessup, M.D. stated that the new guidelines “represent the best of what scientific research can tell us about how to prevent heart disease and stroke.” However, outside experts have already criticized the AHA’s risk calculator, revealing potential flaws in the calculator’s design that could lead to significant overestimation of risk levels. This potential for overestimation, coupled with the statin guidelines’ new lowered thresholds, has left some health experts confused and concerned.
Mehmet Oz, Vice-Chair and Professor of Surgery at Columbia University and host of the popular daytime television show Dr. Oz, stated in his blog that, while statins may be an effective way to help lower cholesterol, he remains concerned that “their benefits may not be as great as many proclaim, and that their downsides have often been de-emphasized.” Oz advised readers to understand that statins come with their own risks, carrying side effects that can include digestive problems, muscle pain or damage, increased risk of diabetes, and, rarely, liver damage.
For people who truly need them, statins can be used to lower bad cholesterol and prevent disease, but studies on their ability to reduce death risk for those without heart disease (especially women) are often inconclusive. Oz believes that cholesterol levels and heart attack risk can be addressed through other methods, specifically those that treat the underlying problem rather than simply relying on a pill. Diet changes, exercise, and not smoking are all methods proven to reduce cholesterol levels and risk of heart disease and diabetes.
For those at very high risk for heart attack or stroke, statins can be an effective treatment option. But some health experts remain concerned by the new statin guidelines, reminding folks that other treatment methodologies can work to reduce risk factors just as effectively. “I am skeptical that statins should form the very first line of defense,” said Oz.
By Katie Bloomstrom