This is not an easy discussion, and I
have some serious doubts about the accuracy and validity of this
study.
You're going over the results of some
blood tests with your doctor. She/he tells you that your “bad”
cholesterol (LDL) level is high. Will you need to take a statin drug
to bring it down? The official answer used to be an easy one, but
lately it's gotten more complicated. This I can agree is true.
For years, there were clear cut-offs --
numbers your doctor looked for. If your levels were above them, then
your doctor was supposed to prescribe a statin plus lifestyle changes
(healthy eating, limiting unhealthy fats, and being more active).
A healthier lifestyle is still
definitely part of the plan. But the statin question changed a bit
when the American Heart Association (AHA) and American College of
Cardiology (ACC) updated their guidelines.
Now the only people who automatically
get a statin based only on their LDL are those whose number is very
high (190 mg/dl or higher). Otherwise, your doctor is also supposed
to look at other things, such as whether you have diabetes and
whether the AHA/ACC's risk calculator predicts that you have at least
a 7.5% chance of having a heart attack or stroke within the next
decade.
It's worth noting that many doctors are
not following these guidelines to the letter, and that they've
generated some controversy.
"I'm not [using them], and nobody
else is, either," says Steven Nissen, MD, chairman of the
department of cardiovascular medicine at the Cleveland Clinic. He
prefers to use a combination of older guidelines and another risk
calculator, called the Reynolds Risk Score.
Regardless of whether your doctor is on
board with the newer guidelines, he or she should also consider other
heart disease risk factors before making a recommendation.
Ultimately, the decision about statins
is yours. You’ll want answers to these questions to help you
decide.
What Can Statins Do for Me? If
you take one, you can expect your LDL cholesterol to drop by anywhere
from 35% to 50% or more, depending on the type of statin you take and
your dose, Nissen says. And that could cut your chance of a heart
attack or stroke.
Statins work in your liver. They block
an enzyme that helps your body make cholesterol. They also lower
inflammation in the arteries and stabilize plaque (cholesterol, other
fatty substances, and clotting agents) that may have built up inside
your arteries, says cardiologist Suzanne Steinbaum, DO, director of
women and heart disease at Lenox Hill Hospital in New York. "That's
more important than anything, because if plaque bursts it can cause a
heart attack or stroke," she says.
Cardiologists generally agree that
statins are a no-brainer for people who've already had a heart attack
or stroke, because there’s strong evidence that they can help
prevent a second one.
There's been some debate as to whether
statins are as helpful in preventing a first heart attack or stroke.
But most experts say there's plenty of proof that they're safe and
effective for this purpose.
If you're at high enough risk for your
doctor to recommend a statin, "I think you can safely say
that a moderate dose will reduce the risk of either a heart attack or
stroke by 30%," says Jennifer G. Robinson, MD, MPH, director
of the Prevention Intervention Center at the University of Iowa.
She notes that several major studies --
including a review of 18 trials based on data on nearly 57,000 people
-- have shown that statins lower the chances of developing both fatal
and non-fatal heart disease, as well as cut the risk of dying from
any cause during those trials. Robinson was vice chair of the team
that developed the AHA/ACC guidelines in 2013.
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