Talking statins

I heard on my car radio that 12.8 million more Americans would receive statins under new cholesterol guidelines. Well, they got the number right.

The American Heart Association/American College of Cardiology’s (AHA/ACC) preventive guidelines published in 2013 created a stir, especially over the use of a risk calculator that critics claimed would expose huge numbers of Americans to statin therapy with dubious benefit. This week, researchers published an analysis in the New England Journal of Medicine that estimated an additional 12.8 million adults between 40 and 75 years old would become eligible for statin therapy under the new guidelines compared with a previously used guideline.

Most of the growth is in the upper half of the age group, and the authors wrote that statin therapy may well be justified in older adults. But, giving statins for primary prevention of cardiovascular disease in younger adults needs to be scrutinized.

The architects of the new guidelines emphasized that physicians should talk with patients who are considered eligible for statins before initiating therapy. That point often appears to get lost in the debate about the guidelines.

ACC President John Gordon Harold, MD, and AHA President Mariell Jessup, MD, agreed to participate in a question-and-answer session with Cardiovascular Business not long after the release of the guidelines. In the session, they repeated that the new guidelines encouraged physicians to discuss risk factors with patients to identify opportunities to change behaviors that increased risk. That could mean a healthier diet, more exercise, smoking cessation—actions within the patient’s control if he or she can be convinced of the benefit.

“The calculator essentially opens up the dialogue and begins the conversation,” Harold said. “[It] is not meant to be a knee-jerk response to begin a drug. It is a tool that allows you to begin a conversation on global risk with a patient.”

Overuse of a drug, even one that is available as a generic and considered safe, increases costs and may hold a potential for harm. This should weigh into decisions for younger adults, where the use of statins may be prolonged and the benefits may be unclear.

But, there also is value in a process that facilitates physician-patient dialog and empowers a patient to make lifestyle changes while still middle age.

The radio report was off the mark on many fronts, including the fact that to be eligible for statin therapy is not equivalent to receiving statins. Hopefully the more subtle message about modifiable behaviors will take place in physician offices regardless.

Candace Stuart

Cardiovascular Business, editor