Winter 2014 - New Statin Guidelines
Statins (Zocor®, Lipitor®, Crestor®, etc.) are drugs that lower cholesterol by inhibiting HMG-CoA – an enzyme that works in the liver to produce cholesterol. The American Heart Association (AHA) and the American College of Cardiology (ACC) recently introduced new heart disease and stroke prevention guidelines. As it happens with many newly introduced medical guidelines, cardiovascular professionals are weighing their pros and cons, particularly as they relate to prescribing statins.
Lifestyle, Heritage, Gender Weighed
“The guidelines are more about the disease process than the numbers,” comments Pratik Desai, MD, an interventional cardiologist with Cary Cardiology. Dr. Desai appreciates the fact that the guidelines now focus on heart disease and stroke prevention by addressing obesity, cholesterol, lifestyle factors and personal disease risk.
“The new guidelines for prescribing statins take into account such things as race and activity in addition to age, family history, medical conditions and other factors in the previous guidelines,” explains Dr. Desai. “The previous guidelines were more numbers-driven. A patient’s blood cholesterol had to be at a certain level before statins were to be recommended.”
Previous guidelines based on limited group
Dr. Desai explains that the previous guidelines from the National Cholesterol Education Program were based on the results of the Framingham study, which began in 1948 and continues today. Researchers recruited more than 5,000 men and women (predominately men) and followed them throughout their lifetime to determine common factors and characteristics of cardiovascular disease. The study continues today with the children and grandchildren of the original participants.
“These guidelines are just that – guidelines. As physicians, it’s up to us to look at the whole person and decide if a statin is appropriate. These guidelines are simply a tool to help us make that determination.”
— Pratik Desai, MD
“The Framingham study has been helpful, but it has limitations,” explains Dr. Desai. “Most of the participants were white males from the same, upper-middle class area of Massachusetts. More recent studies suggest that women and people of African-American decent have high risks of developing cardiovascular disease, may suffer different symptoms of a heart attack than white males and may respond better to different treatments than those administered to white males.”
A tool for physicians
Do the new guidelines mean more people will be prescribed statins? “It’s very possible,” says Dr. Desai. He explains that physicians no longer need to wait for a patient’s cholesterol to reach a certain level. They can use the “CV Risk Calculator” on the AHA’s website to help them determine if statins may benefit patients. “We can recommend and begin preventive statin therapy earlier, which will benefit many patients,” says Dr. Desai.
Some providers do not support the new guidelines. They believe patients will be unnecessarily prescribed statins. While Dr. Desai understands this point of view on the provider side, he offers an important piece of knowledge to patients: “These guidelines are just that – guidelines. As physicians, it’s up to us to look at the whole person and decide if a statin is appropriate. These guidelines are simply a tool to help us make that determination. And, ultimately, it’s up to patients to decide if they want to use statins to help prevent heart disease and stroke. Both patients and providers have a choice.”
For more information about the new AHA/ACC heart disease and stroke prevention guidelines and to check out the new CV Risk Calculator, visit www.americanheart.org.