Experts advise wider statin use to prevent heart attack, stroke

One of the study stated that the new guidelines in a better way can determine who is truly at risk of a heart attack and should be given stations. New research suggests the key may be treating more people with statins.

New guidelines would have 13 million more Americans taking the cholesterol drugs, experts say. Instead, they can provide more proof that the new guidelines actually work and may prevent detractors from giving negative feedback and criticisms later on. Greenland is a senior editor of JAMA and cardiologist and preventive medicine specialist at Northwestern University’s Feinberg School of Medicine. Harvard’s lower threshold may prevent an additional 161,560 cardiovascular events, such as heart attack and stroke, over the lifespan of those now between ages 40 and 75, researchers found. According to the Centers for Diseases Control and Prevention, a quarter of Americans aged 45 and above take statin.

The guidelines, issued by two leading cardiology societies in November 2013, move away from trying to lower cholesterol to particular target levels.

Using a computer simulation, Ankur Pandya and colleagues found the 7.5 percent risk threshold over 10 years would cost about $37,000 per quality-adjusted-life-year (QALY) gained.

The guidelines were contested nearly as soon as they were announced.

Nissen also questions the design of the two Harvard studies for not meeting the highest standards of scientific research.

But some say the studies have too many shortcomings to be persuasive. That number, they said, was “acceptable”.

The first one, published in the Journal of the American Medical Association and funded by the National Institutes of Health, looked at 2,400 people in the Framingham Heart Study who did not take statins and figured out which ones would have been eligible under the new guidelines versus the old ones.

The authors determined which of those participants would have been eligible for statins under the new guidelines and under the old guidelines.

However, the studies will not completely dispel the risk of developing cardiovascular diseases. They found that 39 percent were eligible versus 14 percent.

They can damage muscle in 5 to 15 percent of patients.

If the criteria for treatment with statins were dropped further – a shift that would make roughly two-thirds of the adult population eligible for statins – the authors found the cost higher, but predicted it would avert an additional 125,000 to 160,000 heart attacks or strokes over 10 years.

Among those who would be considered for treatment with statins under the new guidelines, 6% of subjects went on the have a heart attack or stroke, fatal or nonfatal. It will also be better at detecting patients who do not require the use of statins.

Critics said the study did not really test if using statins helped these people.

Experts predicted the 2013 guidelines on the prevention and treatment of heart disease, released by the American Heart Association and the American College of Cardiology, would expand the number of people taking statins, but studies have not yet quantified whether there has been an increase in prescriptions in the year and a half since the guidelines came out.

Levy said he would not be surprised if the threshold for statin use were eventually lowered to a 3 percent risk.

The first of the two studies, led by cardiologists from Harvard Medical School and Massachusetts General Hospital, suggests that widespread adoption of the new risk calculator would be a lifesaving achievement.