BY AMERICAN HEART ASSOCIATION NEWS
Specific groups of people between the ages of 40 and 75 who face increased risk for heart attack or stroke should take cholesterol-lowering statins to prevent those life-threatening events, experts recommended Monday.
The U.S. Preventive Services Task Force, a government-appointed panel of 16 volunteer doctors and scientists who review the latest scientific evidence related to prevention and care, released its draft recommendations for people who face at least a 7.5 percent risk of heart attack or stroke over the next 10 years and have a risk factor such as smoking, high cholesterol, diabetes or high blood pressure.
Statins would be beneficial and are recommended, and the benefit would be even greater if the 10-year risk was 10 percent or more, the task force found. People with an estimated risk of 7.5 percent to 10 percent may also benefit from statins, but since they have less risk at baseline, the task force found the benefit of statins to be less. These individuals should talk to their doctors about potential benefits.
“People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke. Fortunately, for certain people at increased risk, statins can be very effective at preventing these events,” task force member Douglas K. Owens, M.D., said in a statement.
The task force did not find sufficient evidence to indicate whether statins benefited people over age 75.
The recommendations and evidence reviews will be available for public comment on the task force’s website until Jan. 25. There are no timelines, but in general it can take anywhere from a few months to a year before draft recommendations become final, a task force spokesperson said.
“As with all its recommendations, the Task Force hopes to empower clinicians and patients with the latest science,” Owens said. “The Task Force’s recommendation on statin use for the primary prevention of cardiovascular disease in adults reinforces findings from other groups on the benefits of statin use.”
The findings are “very consistent” with the statin guidelines released in 2013 by the American Heart Association and the American College of Cardiology, said AHA President Mark Creager, M.D., director of the Heart and Vascular Center at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
Creager noted some “nuanced differences” but said both relay the same message.
“Overall, the statements are consistent with each other and have a uniform message – patients should meet with their physician, determine whether they’re at high risk for cardiovascular events and, meeting these criteria, should be considered for treatment with a statin medication, as well as lifestyle modifications with a healthy diet and physical activity,” he said.
The AHA-ACC guidelines suggest statin use for people with a 7.5 percent or higher chance for a heart attack or stroke within the next 10 years in the context of a patient-clinician discussion that individualizes the potential benefits and harms for a given patient.
Donald Lloyd-Jones, M.D., one of the 20 experts who wrote the 2013 AHA-ACC recommendations, said the difference simply highlights that statins benefit people facing higher risk for heart attack and stroke.
“We get more bang for your buck with patients at higher risk, after taking all of their cardiovascular risk factors into consideration,” he said. “We will have to treat fewer of them to prevent one heart attack or stroke than if we tried to treat the whole population of lower-risk people.”
Sidney Smith, M.D., past chair of the AHA’s Task Force on Practice Guidelines and also one of the experts who wrote the 2013 guidelines, called the latest proposal “an extensive and thoughtful review of prevention of cardiovascular disease, which should be of value to both clinicians and patients.”
The recommendations also provide “reassuring endorsements” of general concepts put forward by AHA-ACC guidelines, mainly to weigh various risks such as age, race, cholesterol levels, blood pressure, or whether a person smokes or has diabetes, Smith said.
“Using risk as a criteria for treatment, not just blood cholesterol, allows us to identify patients who previously might not have been treated but who definitely could benefit from statins to prevent a stroke or heart attack,” Smith said.
The proposed recommendations also seem to provide reassurance about the safety of statins, saying that the potential harm of taking low to moderate doses are small, the task force said.
While a small percentage of users reported muscle pain, “this side effect was not seen in clinical trials,” the task force said. Reports also have indicated that high-dose statin use may be associated with “a small increased risk of developing diabetes, but more research is needed to better understand this potential harm.”
As with any new recommendations, the most important first step for people at risk is to discuss treatment options with their physicians, Smith said. “These decisions are going to be based upon a thoughtful discussion between doctor and patient,” he said.
Lloyd-Jones said he hopes those talks also will lead to more discussions about the simple things people can do to lower their risk, such as losing weight, exercising, eating healthier and quitting smoking.
“We must focus on improving lifestyle – we’re terrible at that as a society,” he said. “We should not be making recommendations for medication unless we’ve thoroughly implemented reasonable lifestyle approaches. That’s always the right first thing to do.”
“Given the choice between taking a pill or changing behavior, far too many take the pill and continue with the unhealthy behaviors that put them at risk,” he said.