High cholesterol has clearly been associated with an increased risk for heart attack and stroke. Cholesterol is the basis for the formation of fatty plaques in the coronary arteries (arteries that supply nutrients and blood to the heart muscle). When cholesterol levels are high, we are more likely to deposit plaques that can later rupture and form blockages in the coronary artery that result in heart attacks. There is a large body of scientific evidence that has shown that patients with a history of heart disease who regularly take statins have a lower risk for death. Even more impressive, many of the statins that have been studied in rigorous clinical trials have been shown to reduce the size of cholesterol plaques or blockages in the heart arteries that are the cause of heart attack.
For years, physicians have recommended that statins be used to achieve target blood levels of cholesterol, and guidelines have reflected this practice. In 2013, the American Heart Association released new guidelines designed to ensure that all patients who may benefit from statins actually are appropriately treated.
While initially controversial, these guidelines recommend that the following patients be treated with statin therapy:
1. Patients ages 45-70 with a 7.5 percent lifetime risk for developing a heart attack or stroke over the ensuing 10 years. The risk is calculated using a simple online risk assessment tool. Here’s the link to the risk calculator from the AHA.
2. Patients with known heart disease
3. Diabetics ages 45-70
4. Adults with very high levels of LDL cholesterol— a particularly bad form of cholesterol associated with high risk for heart disease
These new recommendations were validated by a study published in July in the Journal of the American Medical Association (JAMA). In the study, researchers found that nearly 45,000 to 60,000 new cardiovascular events would be prevented over 10 years if the new guidelines were followed. In addition, by applying the new guidelines, more patients would be eligible for statin therapy.
Statins do have side effects, and patients must carefully discuss risks and benefits with their physicians. Most common side effects include muscle soreness or weakness (called myopathy), nausea, and liver damage. It is essential that when you take statins, you must work closely with your doctor to monitor for any adverse effects. Blood tests for liver dysfunction are an essential part of monitoring you while on statins.
The bottom line
Cardiovascular disease is the No. 1 killer of American men and women, taking more lives than all types of cancers combined. The decision of whether to take statins is clearly yes for those individuals who have been diagnosed with heart disease. All patients with a history of heart disease or stroke should be on a statin and should continue therapy for life. For those asymptomatic patients without documented heart disease but who may be at risk, it is important to engage in a discussion of risk versus benefit with your personal physician. Every patient is different— and guidelines are just that: guidelines. You must carefully explore your individual risk for cardiovascular disease, stroke and cardiovascular-related death and weigh it against the potential side effects of life-long statin therapy. Certainly diet, exercise and lifestyle modification must be a part of any strategy to reduce risk. However, it is crucial for patients to engage in their own health care and collaborate with their physician to develop a comprehensive plan of prevention.
Dr. Kevin Campbell is the author of “Women and Cardiovascular Disease," and an assistant professor of medicine in the division of cardiology at University of North Carolina at Chapel Hill. For more from Dr. Campbell, visit his website DrKevinCampbellMD.com.