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Heart Health

What the new statins guidelines mean for you

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When the National Heart, Lung and Blood Institute released new guidelines for heart disease prevention last week, it doubled the pool of Americans eligible to take statins – a category of drug that lowers cholesterol and reduces heart risk in patients.

As a result, many Americans might experience changes in the way their primary care physicians and cardiologists conduct future appointments.  Here are four things you need to know about the new guidelines before your next doctor’s visit:

1. Your physician should be looking beyond your cholesterol levels

Previously, patients who inquired about their heart disease risk with their physician would receive guidance based largely on their cholesterol levels. If a patient’s total cholesterol was over 200, or their low-density lipoprotein (LDL) cholesterol was over 100, they would receive a prescription.

However, new guidelines will require physicians to consider a patient’s risk more carefully, based on much broader categories, which de-emphasize the importance of tracking cholesterol while focusing more on lowering a person’s overall risk for heart disease.

“The new guidelines represent a step forward in the care of patients in whom prevention is a focus,” Dr. Carl Orringer, a cardiologist and lipid specialist at University Hospitals Case Medical Center in Cleveland, told

Now, physicians should determine if patient needs statins based on whether or not they already have heart disease, if they have an LDL of 190 or higher or if they are between the ages of 40 and 75 and have type 2 diabetes. Furthermore, a fourth group of people will be eligible to receive statins if they have a 10-year risk for heart disease that is 7.5 percent or higher.

2. Your LDL levels don’t matter quite as much

Cardiologists treating patients with existing heart disease should focus more on reducing overall heart attack risk, rather than simply getting a patient’s LDL below a certain number.  In the past, LDL cholesterol has often been considered the “bad” type of cholesterol, needing the most attention.

“There are no longer specific LDL targets as there were in the past,” Orringer said. “…It should remind these physicians they need to have patients on evidence-based regimens that reduce heart-attack risks. Not regimens that simply lower LDL cholesterol.”

However, while patients’ cardiology appointments won’t change drastically, Orringer said, “ I think this is going to change significantly what happens in primary care offices.”

3. The test your primary care physician should be doing

Visits to a general practitioner should now include an assessment of each patient’s 10-year heart disease and stroke risk factor, according to Orringer. 

The test is easily accessible – available on web sites like – and simply requires physicians to plug in certain factors about a person’s health – including cholesterol levels, blood pressure, gender or whether the patient is a smoker, in order to calculate their risk for heart disease.

“Just plug it in and you get your 10-year risk. It’s easy as pie to use,” Orringer said. “Once you know that, you can give appropriated recommendations to patients.”

4. How to deal with the side-effects of statins

As the number of patients receiving statins increases, physicians will also need to spend more time addressing some of the common side effects of this category of drugs – such as muscle aches.

Statin-related muscle aches typically occur in the front of person’s thighs or in their upper arms. The aches, which are sometimes also described as muscle weakness, occur symmetrically, rather than being isolated to one side of the body.  

And while these aches are typically harmless and easily resolved, a very small number of patients do experience severe generalized muscle aches or sustained muscle breakdown, as well as kidney damage that requires hospitalization.

However, the vast majority of patients taking statins can easily get rid of these side effects simply by working with their physicians to adjust their dosages or experimenting with different brands of the drugs.

“We’ll need education at both the primary care level and specialist level,” Orringer said. “We also need very widespread awareness of what to do if people experience muscle aches because then the issue becomes how does one work with that to provide the best protection needed to reduce risk. The fact that a person gets a muscle ache doesn’t mean they can’t take statins.”

Overall, Orringer said that as more physicians and patients are educated on the new guidelines, there should be significant improvements in rates of heart disease and stroke.

“These guidelines will result in a tremendous increase in the number of people nationwide considered eligible.  But in fact, this is a good thing because what this will do is if doctors learn these guidelines and apply them to patients, there will be a considerable reduction in the need for stents, angioplasties, lower incidences of heart failure, fewer people with strokes …overall it should improve health of individuals in the U.S. substantially,” Orringer said.

Furthermore, the new drug guidelines won’t necessarily translate into increased costs for patients.

“The beauty of this is that statins today are a great value,” Orringer said. “For example, there are many statins you can obtain for 10 cents a day.”