A long-simmering medical debate over a class of drugs used to lower cholesterol burst into the media spotlight across the pond in September 2016. Two British medical journals had accused each other of putting the public’s health in danger. British tabloid the Daily Mail called it the “statins war.”
A study published in the March 2019 Journal of the American Heart Association reported that more than half of patients eligible for statins do not receive them. A majority of those people cited the primary reason as their physicians never offered it.
That’s an amazing figure considering statins are the “gold standard” when it comes to treating high cholesterol, which we explained in our February 2016 article 10 truths about statins and high cholesterol.
Can't Tolerate Statins? New Study Supports Nexletol As An Alternative Cholesterol Medication
Data from the 2008 JUPITER Trial suggest a 54 percent heart attack risk reduction and a 48 percent stroke risk reduction in people at risk for heart disease who used statins as preventive medicine.
Many people are at low risk for heart attack or stroke and do not need to take a statin. Statins are intended to be used by people at high risk of heart disease. Joseph A. Hill, M.D., Ph.D.
The controversy in the United Kingdom started in 2013 when the British Medical Journal (BMJ) claimed statins were being overprescribed to people with low risk of heart disease, and that the drugs’ side effects were worse than previously thought.
Should Healthy People Take Cholesterol Drugs To Prevent Heart Disease?
In September 2016, an article and editorial in The Lancet questioned the BMJ’s claims and accused the journal of causing “measurable harm to public health.” The BMJ responded by asking England’s chief medical officer to create an independent review of the evidence for statins. (It should be noted that doctors in Europe prescribe statins based on different parameters than doctors in the United States.)
In the 2019 study conducted at the Duke Clinical Research Institute, researchers surveyed 5, 693 people from the Patient and Provider Assessment of Lipid Management Registry. A total of 1, 511 patients were not receiving statin therapy despite meeting eligibility requirements, and 59 percent of those people said they didn’t take the medication because it was never offered to them.
Despite these prolonged and often misguided debates, we know the benefits of taking a statin are enormous and largely invisible for people at high risk for heart disease. You don’t see the benefit because it’s the lack of something terrible – such as a heart attack or stroke. Unfortunately, too many people focus on the exaggerated, small risks associated with these life-saving drugs.
Heart Disease: 'good' Hdl Cholesterol May Not Predict Risk
Before conflicting studies and internet myths scare you away, let’s take a look at how we prescribe statins and their potential side effects.
Many people are at low risk for heart attack or stroke and do not need to take a statin. Statins are intended to be used by people at high risk of heart disease. They are the ones who derive significant benefit. Use the American Heart Association’s heart disease risk calculator to start a conversation with your doctor about your personal risk.
For years, we prescribed statins such as atorvastatin (Lipitor) and rosuvastatin (Crestor) almost solely based on a target cholesterol level. We would adjust a patient’s medication until we reached a specific number.
Statins: Common Questions Answered
In 2013, a joint task force of the American College of Cardiology and the American Heart Association released guidelines for treating cholesterol. These guidelines focused on treating the patient based on his or her risk of developing heart disease, not a target number. The guidelines, which were updated in November 2018 and published in the journal Circulation, now emphasize a balance between LDL numbers and assessing cardiovascular disease. For drug therapy, statins remain the first-line of defense for patients who are at high risk for a cardiovascular event.
There are four general categories recommended to determine who is at high risk for a cardiovascular event, such as a heart attack or stroke. We determine whether people:
These are good recommendations in general. But they did generate some controversy, specifically when it came to calculating a patient’s 10-year risk. The risk for heart disease increases as we age and almost everyone’s risk for ASCVD is greater than 7.5 percent by age 65. The risk assessment calculator used in the 2013 guidelines is still recommended in the 2018 cholesterol guidelines, but they also recommend that clinicians talk to patients about factors that can increase their chances of heart disease and stroke, including smoking, weight, high blood sugar, and hypertension, as well as family history.
An End To Heart Disease? Not Quite
Does this mean everyone 65 and older should be on a statin? Most doctors would say no. In those cases, we need to take into account other heart health risks when deciding whether to prescribe a statin.
Our first step in preventing or treating high cholesterol is with diet and lifestyle changes. We know these changes can be difficult to make, but statin therapy is not an alternative to healthy eating and exercise. Instead, it’s an added preventive measure.
As with all drugs, statins carry a risk of side effects. The most common is muscle ache or pain. About 10 percent of people on a statin will develop this, although it is usually fairly mild, and it is entirely reversible — without causing damage to the muscle — when the drug is discontinued. In 1 out of 10, 000 cases, a patient on a statin will develop serious pain and muscle damage. This is so rare that I’ve never seen it in a patient.
How Lowering Cholesterol Can Reduce Heart Disease
Typically, we can eliminate the muscle aches by changing the dose of the statin or switching to a different statin, as the molecular structures of statin medications can be quite different. We usually can find one a patient can tolerate well without side effects.
People believe in science when they get in their car, board an airplane, or use their smartphone. They believe in aerospace and electronic engineering, but some are suspicious of biomedical sciences. It’s time we clear the air once and for all.
Another belief held by some that I find puzzling is the notion that physicians have a personal financial interest in giving their patient a statin (or other drug). Whereas I cannot say definitively that this never happens, it is rare indeed. The very great majority of physicians work hard to do what’s best for their patients, relying on the latest science to plan a course of treatment.
Can't Take Statins? New Pill Cuts Cholesterol, Heart Attacks
Our goal is to decrease your risk of heart disease, heart attack, and stroke. We know that for patients at high risk, statins can do this — and potentially save lives. Before you refuse to take a statin or stop taking a statin, consult your doctor. He or she can explain why you may benefit from the drug or help you find a different statin if you experience side effects.
We are constantly evaluating current methods for preventing and treating medical conditions. In the medical field, it’s important to continually seek better or safer options. But I hope the debates playing out in the media and in online forums will not keep doctors from prescribing statins, or keep patients who truly need statins from taking them.
If you are interested in finding out more information about statins and whether they are right for you or a loved one, call 214-645-8300 or request an appointment online.For many people, lifestyle changes on their own are not enough to bring their high cholesterol down to a healthier level to lower the risk of heart disease. Many people will need to take statins, the main type of cholesterol-lowering drug.
What Is High Cholesterol? What Is Atherosclerosis?
Statins are a type of medicine that are used to lower the cholesterol in your blood, helping to prevent heart disease and stroke.
You might be offered a statin if you have too much LDL-cholesterol (bad cholesterol) in your blood - whether it’s caused by your lifestyle or by genetic conditions which are passed down through families.
Like all medicines, statins can sometimes cause side effects. They usually don’t cause any, but if you do have side effects, it should be possible to switch to another statin or a lower dose, or try a different medicine.
How Heart Disease Differs For Women
Statins work by slowing down the production of LDL-cholesterol in the liver, where it’s made. Because the liver isn't making so much cholesterol, it then takes cholesterol out of your blood to make bile with, so your blood cholesterol levels fall.
Statins slow down LDL-cholesterol production by blocking an enzyme called HMG-CoA-Reductase – the medical name for statins is HMG-CoA Reductase inhibitors. Enzymes are proteins in the body which speed up normal processes. In this case, LDL production.
As well as lowering your LDL-cholesterol, statins can lower your triglycerides too, and high triglycerides are linked to liver disease, heart disease and diabetes.
Breakthrough Drug Targets A Form Of “bad Cholesterol”
Statins can sometimes raise your HDL-cholesterol – the type of cholesterol which helps to clear the fat from of your arteries, but their main effect is lowering LDL cholesterol.
You might be prescribed a statin if you have heart disease or another disease of the heart and blood vessels, or if you are at risk of developing them in the next 10 years.
You should be offered a statin if you have high cholesterol and lifestyle changes haven’t been enough to bring it under control.
High Cholesterol In 30s, 40s, Increases Later Risk Of Heart Disease
Depending on your cholesterol levels and how healthy you are otherwise, you and your doctor or nurse might
0 comments:
Post a Comment