In yesterday’s column I began to answer a reader’s question as to what I thought about the new statin guidelines. Today, I finish my necessarily long-winded answer.
Statin drugs have (at least) two powerful effects. They lower blood levels of LDL cholesterol (so-called “bad” cholesterol). They also fight inflammation. Old guidelines said doctors should prescribe statins for people whose LDL cholesterol levels were high. New guidelines say that doctors should prescribe statins to people who are at high risk for heart disease, even if their LDL cholesterol levels are not high. These guidelines are controversial.
What are the risk factors for heart disease? Age is a risk factor: The older a person is, the more likely he or she will have heart trouble.
Another risk factor is gender. Until they reach menopause, women are less likely to develop heart disease than men. That probably is because a woman’s estrogen (female hormone) levels slow the development of atherosclerosis. Plaques of atherosclerosis are the cause of most heart disease in developed nations. In the United States, the average age of menopause is 51.
Yet another risk factor is other close relatives (parents, siblings) with heart disease — particularly at a young age. Still other risk factors are high blood pressure, diabetes (including pre-diabetes), and eating lots of refined carbohydrates with a high glycemic load. If you are a smoker, or past smoker, that raises your risk. Obesity, lack of regular exercise (even if you are not obese) and chronic kidney disease are risk factors.
Personality plays a role, too. People who suffer from depression or people who frequently become angry are also at increased risk.
To determine your risk of heart disease over the next 10 years, there are several different formulas. Your doctor (or you, online) can plug your risk factors into a formula, and back comes your heart disease risk. Here’s a link to one formula.
The new guidelines my reader asked about, published in 2013, recommended a statin for anyone between 40 and 75 years of age who has a 7.5 percent or higher risk of having a heart attack or stroke over the next 10 years. The guideline writers proposed a new formula for calculating the risk.
Some experts worried that the new guidelines could overestimate the risk of having a heart attack or stroke. If so, lots of people would end up taking a statin, get little benefit from it, and perhaps suffer side effects such as muscle pain. A recent study led by Harvard researchers, published in the Journal of the American Medical Association, seemed to show that the worry was unwarranted.
My conclusion: The new guidelines appear to be an accurate way to decide who should be taking a statin. With new information coming in all the time, I reserve the right to change my mind. If I do, I’ll let you know.