Cardiovascular disease remains the leading cause of death in the U.S. To reduce our vascular disease burden, new national cholesterol guidelines recommend statin medication for more adults and at higher doses.
Since some of the changes are confusing, this column will address several questions.
Benefits of statins?
The new guidelines recommend statins for four sets of people at risk for heart attacks, strokes and other serious vascular events. In such patients, statins were well proven in many large clinical trials to prevent up to one-third of major events, which is better evidence than we have for any other drug, diet or supplement.
Statins stabilize arteries by lowering LDL, the "bad” cholesterol (again better than any other treatment), and by reducing inflammation in the artery wall. Combined treatment with statins and low doses of aspirin prevent up to one-half of heart attacks and strokes. Not a bad deal.
The four statin treatment groups are those with:
a) known vascular disease,
b) LDL or "bad cholesterol" over 190, which is very high and probably indicates a genetic problem,
c) diabetics over age 40 with LDL above 70 and
d) non-diabetics with calculated 10-year vascular event risk of at least 7.5 percent.
In the first two groups, most were already receiving statins under old guidelines, but the next two groups have expanded.
Diabetes is important because it doubles the risk of vascular events. Ten years ago, we already knew from a study called HPS that diabetics benefitted from statins regardless of their cholesterol levels, but statins were costly and experts hesitated to expand treatment so dramatically. So old guidelines limited treatment to diabetics who could not get their LDL under 100 with diet and exercise. Today, with statins costing much less, we want to help more patients.