Statin Misinformation: Mayo Clinic Radio
Do You Need Cholesterol Meds?
Last year, the American Heart Association and the American College of Cardiology releasednewguidelines for who should take statins, a type of medication designed to lower LDL ("bad") cholesterol. At least 30 million Americans use the drugs, but if physicians follow the recommendations, even more people will be filling prescriptions for drugs like atorvastatin (Lipitor). But some experts wonder if the guidelines are too broad, leading people to take medication unnecessarily. Here's what you need to know.
1. For certain people, statins may be necessary.
If you've already had a heart attack or a stroke, it's likely that your doctor will tell you that you need medication. That's because evidence is very strong that statins can help prevent a second incident, reducing your risk of death, says Robert Bonow, MD, professor of cardiology at Northwestern University Feinberg School of Medicine and member of theWoman's DayHeart Health Advisory Board. Statin therapy is also essential for most people whose LDL cholesterol is 190 mg/dL or greater, which is considered extremely high.
2. Your doctor needs to do some sleuthing.
Assuming you haven't had a cardiac event, then family history, smoking, blood pressure, age, gender and ethnicity are all factors your physician should consider in deciding whether statins are a smart option for you. She will enter these details into the risk calculator (try it yourself by downloading the ASCVD Risk Estimator app). If it predicts that your risk of having a heart attack or stroke within the next 10 years is at least 7.5%, a statin may be a good idea—but even then it's not a given. "If someone has a score of 9% but she's in her 20s and eating well, I might not suggest a statin," says Dr. Bonow. Similarly, a woman with a 7% score might consider medication if she's over 50 and has a family history of heart disease. Another point you should know: Studies have clearly shown that statins are effective in reducing death among men with an elevated risk of heart disease, but the proof that they work just as well in women isn't quite as strong. "That doesn't mean that they don't, but since we have a little less data on women, it's critical that the discussion you have with your doctor be highly individualized toyoursituation," says Sharonne N. Hayes, MD, founder of the Women's Heart Clinic at the Mayo Clinic in Rochester, MN, another member of theWoman's DayHeart Health Advisory Board.
3. The drugs are generally safe, but the side effects are real.
"Statins have been around for 40 years, and for the most part they're well tolerated," says Dr. Hayes. Still, about 5% of people who take them experience muscle pain or, more rarely, liver problems. Sometimes, switching drugs or tweaking the dose can alleviate the muscle ache issues, says Dr. Bonow. In fact, research from the Cleveland Clinic shows that 73% of patients believed to be statin intolerant (those who experience side effects) were OK after switching to another drug in the class or taking the meds every other day instead of daily. But, in some cases, a person may need to stop taking the pills altogether in order to remain active. "If it comes down to statins or exercise, I'd rather have you exercise because it's more beneficial in the long run," says Dr. Bonow.
4. Overall healthy habits are still key.
"Statins are not a 'get out of jail free' card," says cardiologist Stacey Rosen, MD, vice president, Women's Health, Katz Institute at North Shore-LIJ Health System. Women who are serious about reducing their risk of dying from cardiovascular disease need a multipronged strategy: Getting plenty of physical activity, cutting back on processed, high-fat foods, managing stress and slimming down are all crucial. These changes should go hand in hand with any heart-disease prevention or treatment your doctor prescribes.
If you have type 2 diabetes, your doctor may suggest a statin even if your LDL doesn't seem high. The reason: Diabetes can escalate your risk of heart complications later in life.
Video: Mayo Clinic Experts Advise Caution with New Cholesterol Drugs- PCSK-9 Inhibitors
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