DEAR DOCTOR K:
My doctor never recommended statins to me, but he says there are new guidelines, and thinks that I should now start taking one. What do you think of the new statin guidelines?
The new guidelines make a lot of sense, because we’ve learned that statins have more effects on the body than just lowering cholesterol.
Statins were developed after a Nobel Prize-winning discovery in the 1970s revealed how the body makes cholesterol. Most of the cholesterol in our body is made by our body, not consumed in our food. Statins slow the production of LDL (“bad”) cholesterol by the body.
In the 1980s, studies showed that statins dramatically lowered blood levels of LDL cholesterol and also lowered the risk of heart attack. At first, we assumed that the lower risk of heart attack was entirely explained by the lower cholesterol. That’s because we knew that people with high LDL cholesterol in their blood had higher rates of heart attack.
But then a large study conducted at Harvard Medical School found that statins profoundly lowered the risk of heart attack, even in people with normal total and LDL cholesterol levels.
That’s because statins do more than just lower cholesterol. Heart attacks occur when cholesterol-filled plaques in the heart’s arteries rupture, causing a clot that blocks blood from getting to the heart. Inflammation inside the plaques causes them to rupture — and statins reduce inflammation.
This realization changed the way doctors think about statins. If statins lower the risk of heart attack even in people with normal cholesterol levels, then we should give them to people at high risk for heart attack — regardless of their cholesterol level.
The American Heart Association (AHA) and the American College of Cardiology issued new statin-prescribing guidelines in November 2013. Until then, doctors prescribed statins to reach specific cholesterol goals or targets. Instead, the new guidelines ask doctors to prescribe statins based on a patient’s overall heart and artery disease risk.
Specifically, the new guidelines recommend that patients in any of the following groups be treated with a statin:
- People who already have heart or artery disease;
- People with very high levels of LDL cholesterol (190 mg/dL or higher);
- Anyone between the ages of 40 and 75 who has Type 2 diabetes;
- Adults aged 40 to 75 years who have a heart disease or stroke risk of 7.5 percent or greater in the next 10 years. You can get a sense of your risk by using the AHA’s risk assessment tool at: heart.org/gglRisk/main_en_US.html.
Of course, all drugs have some risk. Statins can cause muscle cramps and, rarely, more serious muscle injury and liver problems. It’s a matter of balancing your personal risks and benefits. For most people covered by the new guidelines, I believe the benefits of statins are greater than the risks.
Although I don’t know the specifics in your case, I’ll bet the reason your doctor now is recommending statins is that you are at high risk for heart disease, even though your cholesterol levels are not particularly high. If so, I would agree.
(This column ran originally in November 2014.)