November 5, 2016

Many Doctors Hesitant about Statins – Part 1

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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