ThermionicScott 

*bump*

I heard on the radio this morning that the movement to put more people on statins is gaining momentum, not losing it. From the New York Times:

The JAMA study concluded that medicating this new group of ~10 million people even made economic sense, even though many might never have otherwise developed heart disease or had heart attacks.

I found the radio program interesting and reasonably well-balanced, but I still wonder if eventually the recommendations will expand to put everyone on some level of statins...

GeorgeBMac

This is an old issue -- but still a timely update because yes, the ACC/AHA & big pharma continue to try to sell these new guidelines...

My personal experience with medical literature and medical forums have shown me that this remains a highly contentious issue even in the medical community...

Many health care professionals -- particularly cardiology specialists -- have rejected these new ACC/AHA standards. Mostly they question replacing the former LDL targets with the new "risk calculator" developed along with these new guidelines. They say that there is no reason to drop the LDL targets which are valuable medical tools for prescribing and that the "risk calculator" has been shown to be highly inaccurate and overstates risk by over 50%. The ACC/AHA insist that these new guidelines are "evidence based" -- but others insist they were bought & paid for by the pharmaceutical industry.

On a more individual level, many health care professionals question the published and accepted side effect profiles of these drugs: They say that statin drugs are not as safe as the industry claims they are. Specifically: they site concerns that these drugs cause things such as diabetes, muscle weakness, and musculo-skeletal injuries by affecting the metabolic system. They also claim that that these drugs cause memory loss and dementias. The industry claims that they have not proven that these effects can be attributed to statin drugs or marginalizes them by saying things like "diabetes is preferable to a heart attack".

In addition, while statin drugs have been proven to be effective in preventing a second heart attack, there is much debate on their effectiveness in "primary prevention" (meaning preventing a heart attack in those who have never had one before).

For myself: I see the heart of these new standards being the replacement the former LDL targets with the new risk calculator -- which essentially says that a person should be put on high dose (or at least a medium dose) of a statin drug whenever the calculator 'determines' the person has a =>7.5% risk of a heart attack over 10 years. Yet the calculator uses things such as age and blood pressure to measure risk. So, while those things may effect a person's risk, they do not have any impact on a person's cholesterol -- so why would you prescribe him a cholesterol lowering drug to treat age or high blood pressure? Despite the ACC/AHA claims that these guidelines are "evidence based", there is not a shred of RCT evidence to back up this up.

In practice, it means anybody with high blood pressure and/or who has turned 63 or 64 should be prescribed a high dose of statin drugs -- the ones that have been shown to have the highest levels of adverse side effects. But again, I fail to see why you would prescribe a potentially dangerous cholesterol lowering medication to treat either high blood pressure or old age.
... This puts these drugs on the same level as snake oil. "Just one pill a day will cure you of all ills..."

Unfortunately, many physicians -- particularly PCPs who don't know any better -- are starting to adopt these standards.

And, it is these same physicians who ignore the first recommendation of these guidelines saying that lifestyle modification (diet, exercise, weight loss) should be the FIRST thing tried before prescribing these drugs. Typically they claim that lifestyle changes are not effective and/or that people won't do them -- so they just go straight to the drugs. Or, if the person chooses lifestyle over drugs, they provide no support -- just skepticism.

In addition: the new standards have that covered anyway because: once you turn 64 the calculator says you should be taking a high dose statin regardless of your lifestyle and its effect on your health.

For myself: I recognize that these drugs can and do save lives. But like any medication, you have to weigh their good effects against their bad. And, like war, it should always be the last option. Unfortunately, big pharma is twisting and distorting the information required to make good decisions and are using these guidelines to push physicians into prescribing them to more and more people.

Carbonfiberboy 

^ Yep. Right after the new ACC/AHA standards went into effect, I had a physical. IIRC, I was 69. Doctor said that by the guidelines, I should be put on a statin, even though my LDL was very good and my BP was exceptional for any age. Being a good doctor, he said he wouldn't advise statins in my case. It's "evidence based" in that statistically old folks die of heart attacks and statins do lower the risk of same. Fortunately, not every doctor thinks people are merely statistics.

Dunbar

What's also interesting is that there doesn't appear to be scientific evidence of a benefit to using statins once you reach age 70. But I bet many doctors still continue to prescribe them over that age.