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New study evaluates who might benefit from statin therapy

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The indications for statin therapy to lower cholesterol levels were expanded by the 2013 guidelines of the American College of Cardiology and the American Heart Association (ACC–AHA). A new study assessed which individuals would now be included in the recommendation for statin therapy to reduce the risk of cardiovascular disease. The findings were published on April 10 in The New England Journal of Medicine.

The investigators accessed data from the National Health and Nutrition Examination Surveys of 2005 to 2010 and estimated the number, and summarized the risk-factor profile, of individuals for whom statin therapy would be recommended under the new ACC–AHA guidelines. They compared them to the individuals who would be recommended for treatment by the guidelines of the Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program.

The investigators analyzed the data and expanded the results to a population of 115.4 million American adults between the ages of 40 and 75 years. They found that, compared to the old guidelines, the new guidelines would increase the number of U. adults receiving or eligible for statin therapy from 43.2 million (37.5%) to 56.0 million (48.6%). Furthermore, the majority of the increase in numbers (10.4 million of 12.8 million) would occur among adults without cardiovascular disease. Among adults between the ages of 60 and 75 years who do not have cardiovascular disease and are not receiving statin therapy, the percentage who would be eligible for statin therapy would increase from 30.4% to 87.4% among men and from 21.2% to 53.6% among women.

The authors note that the aforementioned increases would be fueled primarily by an increased number of adults who would be classified entirely on the basis of their 10-year risk of a cardiovascular event. The newly eligible individuals comprises more men than women and those with a higher blood pressure but a significantly lower level of low-density lipoprotein cholesterol. Compared to the old guidelines, the new guidelines would recommend statin therapy for more adults who would be expected to have future cardiovascular events; however, they would also include many adults who would not suffer a future cardiovascular event.

The authors concluded that the new ACC–AHA guidelines for the management of cholesterol would increase the number of individuals who would be eligible for statin therapy by 12.8 million; furthermore, the majority of the increase would be among older adults without cardiovascular disease.

The authors are affiliated with Duke University (Durham, NC), Boston University (Boston, MA, Harvard Clinical Research Institute (Boston, MA), KenAnCo Biostatistics (San Antonio, TX.), and Royal Victoria Hospital, McGill University (Montreal, Canada). The study was funded by the Duke Clinical Research Institute and others.

Take home message:

Guidelines are just that—guidelines. Before beginning statin therapy, you should thoroughly discuss benefits and risks with a physician. Controversy exists as to who should receive statins. For example, in a book written by a cardiologist and a PhD nutritionist, the recommendation should be primarily limited to men who have suffered a cardiovascular event. Adverse effects of statins include an increased risk for type 2 diabetes and memory problems.

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