Cardiovascular disease is the leading cause of death in the United States. Heart disease kills more than half a million people annually, according to the Centers for Disease Control and Prevention.
Recent guideline changes to preventative prescriptions could help in the battle – but not without a little controversy.
An updated heart attack risk calculator was recently released by the American College of Cardiology and the American Heart Association, along with four new guidelines for statin use.
Patients with a 10 percent or greater chance of suffering a heart attack or stroke were prescribed the medication. Now doctors may prescribe medications to those with a risk greater than 7.5 percent. The number of statin users could double as a result, says Dr. David Sabgir, clinical cardiovascular specialist at Mount Carmel Medical Group and a member of the Healthy New Albany Magazine Advisory Board.
“(Originally,) 15.5 percent of adults were recommended statins,” Sabgir says. “Now, they will be recommended to 31 percent of adults.”
Statins reduce the amount of cholesterol in the blood by inhibiting the enzyme HMG-CoA reductase from being produced. This enzyme is active in cholesterol production in the liver.
Not every doctor agrees with these changes, and the findings are based on limited data, Sabgir says.
“Suppose we know that your heart attack or stroke risk in the next 10 years is 20 percent or more – that data is very solid. You need to be on a statin,” he says. “However, the data between 7.5 and 10 percent is limited. Some people say, ‘What’s it going to hurt?’ But you have to be careful of what you put in your body.”
Even if someone reaches the threshold of statin recommendation based on the ACC and AHA calculator, his or her actual risk percentage may be lower than the test shows.
“The kicker is a lot of those numbers that come out as a 7.5 percent risk may actually be a 2.5 or 3 percent,” Sabgir says.
According to medical journal The Lancet, the calculator greatly overestimates the risks, sometimes by as much as 75 to 150 percent.
“The panel that made this decision is not free of commercial bias,” Sabgir says. “Some of them are being funded by drug companies, so you have to consider the source, but that doesn’t mean they’re making decisions that will hurt (people).”
The other three changes to the guidelines are less controversial and are generally agreed upon.
Patients with LDL levels greater than 190, those who have had coronary heart disease previously and those who are between the ages of 40-75 and have LDL between 70 and 189 will be recommended a statin to help control cholesterol levels.
Statins are relatively effective and side effects are mild, but the drugs shouldn’t be taken lightly.
“You need to treat 140 people to save one heart attack,” Sabgir says. “Of those 140, 18 percent of those people will experience myalgia, slight increase in diabetic risk in women, sexual dysfunction and possible liver problems. If the patient is stricken with one of these, it goes away as soon as treatment ends.”
Statins also run the risk of reacting poorly with other medications. Communication with a doctor is advised before starting treatment.
“By definition, every medicine is a poison,” Sabgir says. “It is reacting with something in your body and you have to decide if it is worth that risk.”
Costs for these medications are another concern. While some drug stores give the generic version of the medication out free of charge, the name brands such as Crestor often come with a problematic price tag.
“Cost varies for each person, but it is not small,” Sabgir says. “Most doctors would be better off starting their patients on one of these generic drugs.”
While increased statin use brings along a little extra baggage, there are some positives to the new guidelines and the change was rooted in trying to help.
“There’s a lot of good to this,” Sabgir says. “People are going to be talking to their doctors more. It will need to be a discussion between a patient and their doctor.”
Check with your doctor to get an accurate cholesterol reading and remember that cholesterol isn’t the only factor in heart disease and stroke risk, Sabgir says.
“Cholesterol is only one part of the risk,” he says. Other factors include age, gender, blood pressure and whether or not a patient is a smoker. Lifestyle change is the key to decreasing heart disease and stroke risks and the eventual need for a statin.
“The main things that aren’t included in the risk calculator are exercise, following a good diet of lean protein, fruits and vegetables, not smoking and keeping a healthy body weight,” Sabgir says. “If you keep up with these things, the odds of you needing a statin will decrease significantly.”
Stephan Reed is an editorial associate. Feedback welcome at laurand@cityscenemediagroup.com.
