Panel Recommends Statin Drugs For Many Over Age 40
Heart disease, stroke, and other cardivacsular complications killed nearly 800,000 people in 2011, according to the American Heart Association.
A government task force said that the common medications are going to be most useful to some people from age group 40 years to 75 years, whose cardiovascular disease risk is at least 10% over the coming decade.
In fact, the people taking the cholesterol-lowering drugs were 17 percent less likely to die from any cause than their non-statin taking counterparts. This is a “C” recommendation.
“People with no signs, symptoms or history of cardiovascular disease can still be at risk for having a heart attack or stroke”, said USPSTF member Douglas Owens, M.D., M.S., in a news release.(www.uspreventiveservicestaskforce.org) “Fortunately, for certain people at increased risk, statins can be very effective at preventing these events”.
The guidelines have been based on the assessment of 18 clinical trials of statin use among adults aged over 40.
Doctors can calculate people’s risk of heart disease by using an online calculator available through the American Heart Association’s web site – which the task force endorses.
The panel also points out that the American Academy or Pediatrics (AAP) and the National Heart, Lung, and Blood Institute endorse universal screening for all children before ages nine and 11, and again between puberty and adulthood.
The new recommendation isn’t surprising and is consistent with 2013 recommendations from the American Heart Association and American College of Cardiology, according to Dr. Sekar Kathiresan, who wasn’t involved with the new recommendation but is director of preventive cardiology at Massachusetts General Hospital in Boston.
Those whose 10-year risk is at least 7.5 per cent might benefit from a statin as well – but they should discuss it with their doctor beforehand, the task force suggested. People who feel fine may think the drugs aren’t really needed, or may not be willing to spend the money or put up with possible side effects. “It doesn’t clarify for prescribers and for patients what they should do”.
Cholesterol can contribute to a person’s risk of heart attack and stroke. It found there wasn’t enough evidence to assess the balance of benefits and harms of screening in this age group, and the recommendation remained unchanged from its previous “I” version. This is unchanged from a 2007 recommendation.
Donald Lloyd-Jones, MD, a member of the USPSTF panel from Northwestern University noted: “There has been some debate in some quarters that we shouldn’t use statins for primary prevention because they don’t reduce total mortality”, he said. Of note, a separate report about children concluded that the evidence was inadequate to recommend for or against lipid screening. Up to now, the task force has mainly focused on the best screening methods for detecting heart disease.
Homozygous familial hypercholesterolemia and secondary causes of dyslipidemia (e.g., diabetes, nephrotic syndrome or hypothyroidism) were outside the scope of review.
They also recommended statins for younger individuals with excessively elevated LDL (“bad” cholesterol).
The recommendations are open for public comment until January 25.