Statins needed for those at high risk of heart attack, stroke, expert panel reiterates

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A national panel of experts has reiterated its call for people between the ages of 40 and 75 who are at high risk for a first heart attack or stroke to take statins. Photo by Whispyhistory/Wikimedia Commons

Armed with updated scientific evidence, an authoritative panel of experts on Tuesday reiterated its call for people between ages 40 and 75 to take cholesterol-lowering statins if they are at high risk for a first heart attack or stroke.

The U.S. Preventive Services Task Force, in a recommendation statement published in the journal JAMA, again said people between 40 and 75 years of age who are at increased risk, but not at high risk, may benefit from statins and should discuss the decision with their doctors.

The panel added that more research is needed to determine whether people ages 76 and older should begin taking a statin to prevent a first heart attack or stroke.

The national task force had published similar recommendations in 2016, citing statins as an important tool in preventing heart disease and stroke, the leading causes of death in the United States.

Every year, 877,500-plus Americans die of heart disease, stroke, or other cardiovascular diseases, accounting for 1 in 3 deaths in the United States, according to the Centers for Disease Control and Prevention. Heart disease and stroke are the first and fifth leading causes of death, respectively.

The task force’s new guideline on statins goes a step further than previous guidance. It asserts that despite the effectiveness of statins in lowering the risk of heart attacks and strokes, inequities persist in the rates of cardiovascular disease — as well as access to statins and their use — among Black, Hispanic and Asian adults compared with White adults.

And the panel urged research to improved understanding and eliminate these inequities.

Dr. John Wong, a task force member, and interim chief scientific officer and an internist at Tufts Medical Center, told UPI in a phone interview that there is “increasing recognition” of disparities. Black adults have the highest rates of heart attack and stroke, he said.

Wong cited a national survey showing 58% of White, non-Hispanic individuals in the United States who are eligible for statins are prescribed the medication. That compared with 44% of Black non-Hispanic, 49% of Asian, and 34% of Hispanic people.

“We also noticed Black, Hispanic and Asian adults are less likely to receive a prescription for a statin, so we call for more research to understand the sources of that and improve access to those medications.

In the meantime, Wong said, the task force is urging physicians to be aware of the importance of discussing with patients the use of statins as a potential way to lessen their risk when warranted.

Wong said the task force looked at 23 clinical trials and three observational studies on statins, together involving more than half a million patients, “and the evidence continues to show that statins are an important tool” to help high-risk individuals prevent a first heart attack or stroke.

“And we want to make sure all people can benefit from this knowledge,” Wong said.

He noted that the experts looked at 19 trials, involving tens of thousands of patients, and found no evidence of harmful effects from statins, as compared to a placebo. “We often hear about muscle discomfort or weakness … or liver function abnormalities,” but the evidence didn’t support such issues, or problems related to cancers.

One study found an increased risk for diabetes with statin use, but the researchers used “high-intensity” statins, and this result wasn’t found in other studies using the medication at regular doses, he added.

“Overall, we find small risk for any harm,” he said. “This is one of those situations where we found the benefits outweigh the harms for those at high risk, in particular, who have hypertension, diabetes or who smoke.” benefits outweigh the harms for those at high risk, in particular.”

For people ages 40 to 75, determining the risk of cardiovascular disease is based on their estimated chance of having a first heart attack or stroke over the next 10 years, and whether they have risk factors, including high cholesterol, high blood pressure, diabetes and smoking.

Generally speaking, the task force’s guideline remains quite similar to the American College of Cardiology-American Heart Association recommendations on statin use issued in 2018, Wong said.

“Where they differ a bit is the terminology they use and the risk threshold,” he said.

For example, the task force defines “high risk” as someone with a 10% or higher chance of heart attack or stroke over 10 years; someone with a 7.5% chance is considered at “increased risk.”

By contrast, the cardiologists define high risk as having a 20% or higher risk of art attack or stroke over 10 years; intermediate risk ranges from a 7.5% chance to under 20%. And the Department of Veterans Affairs defines high risk at 12% or higher.

Across the recommendations, “it’s all about adults at higher risk getting more benefit [from statin use] than individuals at lower risk,” Wong said. “And none of these organizations recommend a statin for everyone.”

Cardiologists agree on the need to treat high-risk people first, Dr. Salim S. Virani, professor of cardiology and cardiovascular research at Baylor College of Medicine in Houston, told UPI in a phone interview.

But he cites some important differences in cardiologists’ approach, including their inclusion of “risk-enhancing” factors in their 2018 recommendations on statin use.

If, for example, a 52-year-old individual is calculated to be at moderate risk, but their father or mother had their first heart attack at 53, and they’ve worked on healthy lifestyle behaviors and diet, they may be offered a statin, Virani said.

Other “risk-enhancing” factors include chronic kidney disease, premature menopause ore preeclampsia or high blood pressure during pregnancy — all of which should prompt a discussion about statins with a patient even if they’re at intermediate risk, he said.

Another difference is that the cardiologists call for every diabetic adult between the ages of 40 and 75 to be automatically considered for statins, regardless of their meeting a certain risk threshold.

“Diabetes is a very high-risk condition and those patients should be treated very aggressively early on to prevent a first heart attack or stroke,” Virani said.

The bottom line, according to Virani, statins are under-prescribed despite 40 years of evidence of their safety and efficacy.

He attributes this partly to physicians being extremely busy, so they may feel they lack the time to have a discussion about statins and calculate risk scores with patients.

He also cited “a lot of resistance from patients” who have been misinformed of potential side effects of statins on social media.

Yet, Virani said every adult should know their estimated 10-year risk of heart attack or stroke, and have a discussion with their doctor. “And they should decide on statins in the doctor’s office, not over the Internet,” he added.

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