Do I need a statin? New study suggests some with a prescription may not.

A new way to determine heart disease risk could result in millions of Americans receiving fewer prescriptions for statins, a new study suggests. Cardiologists, however, cautioned that more information is needed and that patients should not stop taking their medications.

Statins, such as Lipitor, Crestor, and Zocor, are widely used to protect against high levels of LDL cholesterol, one of the causes of cardiovascular disease. Doctors prescribe the daily pills based on 2013 guidelines from the American Heart Association and the American College of Cardiology, which estimate risk based on a patient’s age, diabetes, blood pressure and other factors.

For the new study, Dr. Tim Anderson, an assistant professor of medicine at the University of Pittsburgh, and colleagues analyzed the potential impact of a new heart disease risk calculator, called PREVENT, released last year by the American Heart Association. Examining data from 3,785 adults, ages 40 to 75, who participated in the National Health and Nutrition Examination Survey (NHANES), researchers compared the new calculator’s estimates to the old guidelines.

The Heart Association’s new calculator has been developed to give a more accurate assessment of a person’s likelihood of developing heart disease by incorporating newly recognized risk factors, such as kidney disease and obesity.

Researchers found that among participants, the 10-year risk of developing heart disease determined with the new tool was about half that estimated with the previous one, according to the report published Monday in JAMA Internal Medicine.

Using PREVENT to calculate the 10-year risk of developing heart disease, researchers determined that about 40 percent fewer people would have met the criteria for a statin prescription.

In other words, up to 4 million people in the United States are currently taking statins for primary prevention – that is, they have not had a cardiovascular event such as a stroke or a heart attack — might not need it, said Anderson, lead author of the new study. study.

How is the new calculator different?

Among other factors, the new tool:

  • Removes race from the calculation and replaces it with a person’s ZIP code, which serves as an indicator of socioeconomic status.
  • Includes factors that may increase the risk of heart disease, such as kidney disease, obesity, and a marker of poor blood sugar control (hemoglobin A1C).
  • Calculates risk separately for men and women.

The new findings are an opportunity for people who take statins for primary prevention to ask their doctors whether they should continue taking the treatment, Anderson said. While it is important to treat heart disease risks before a first event, statins can cause side effects in some, including muscle pain, headaches, sleep problems and digestive problems.

“Patients who are on the border should be aware that there are other things that are not taken into account by these calculators, such as family history, so it is very important to discuss this with their doctor,” said Anderson.

Cardiovascular disease experts expressed concern that the new study could convince some patients to stop taking their medications, especially since many people already stop taking statins against their doctors’ advice.

With the new risk calculator, there will need to be new guidelines to accompany it, said Dr. Sadiya Khan, chair of the PREVENT development committee and professor of cardiovascular epidemiology at Northwestern University’s Feinberg School of Medicine.

“Risk models do not determine who is recommended to take statins, guidelines do,” Khan said. “I think the most important thing is to determine when it will be recommended to start taking statins. This has not yet been decided. »

Dr. Robert Robinson, director of lipids and metabolism at Mount Sinai Health System in New York, cautioned that the small number of study participants was not representative of the U.S. population.

“Their main argument, that fewer patients should be eligible for statins, is based on the limited number of people in the NHANES database,” Robinson said. “It’s alarming.”

Dr. Shaline Rao, director of heart failure services at NYU Langone Hospital on Long Island, worries that patients who actually need cholesterol-lowering medications are getting the wrong message.

“We see many benefits of statins in many populations,” Rao said.

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Gn Health

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