To Statin or Not to Statin?

Released: 25-Mar-2015 3:25 PM EDT Embargo expired: 30-Mar-2015 2:00 PM EDT Source Newsroom: Johns Hopkins Medicine Contact Information

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Newswise Cholesterol-lowering statins have transformed the treatment of heart disease. But while the decision to use the drugs in patients with a history of heart attacks and strokes is mostly clear-cut, that choice can be a far trickier proposition for the tens of millions of Americans with high cholesterol but no overt disease.

Now a report from preventive cardiologists at Johns Hopkins and elsewhere offers a set of useful tips for physicians to help their patients make the right call.

The report, published March 30 in the Journal of the American College of Cardiology, combines the experts collective clinical wisdom with previously published research on the benefits and potential downsides to long-term statin use.

Given that heart disease tops mortality charts as the number one-killer of Americans, to statin or not to statin is one of the most important questions faced by patients and physicians alike, says lead author Seth Martin, M.D., M.H.S., an assistant professor of cardiology at the Johns Hopkins University School of Medicine and the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Our report offers concrete tips for clinicians on how to conduct this vital discussion and to reduce patient uncertainty and frustration in making this complicated decision.

Atherosclerotic heart disease the most common form of the disease develops gradually as fat builds inside the blood vessels and makes them stiff, narrowed and hardened over time, greatly reducing their ability to supply oxygen-rich blood to the heart muscle and brain. Statins work by lowering the amount of circulating cholesterol in the blood and halting or slowing the formation of dangerous fatty plaque. Rarely, however, statins can precipitate the onset of other serious conditions, including muscle damage and diabetes. The risk of such infrequent side effects pales in comparison with the very real risk of heart attack or stroke among those with established heart disease or history of stroke. However, the risk-benefit balance is much trickier to gauge among those who have no actual disease but whose high cholesterol and other risk factors render them likely yet not definite candidates for heart attacks and strokes.

The latest guidelines from the American Heart Association and the American College of Cardiology, state that in those with high cholesterol but no overt heart disease, the decision to start preventive statins typically as a lifelong therapy should factor in a patients likelihood of suffering a heart attack or stroke over the next decade among several other variables. The guidelines recommend considering preventive therapy in those whose 10-year risk score for suffering a heart attack or stroke is 7.5 percent or higher, but they leave a lot of room for variation, the authors of the report say.

That decision should be informed by the intersection of scientific evidence, clinical judgment and patient preference, but clinicians need to individualize the advice, says study author Neil J. Stone, M.D., Bonow Professor of Medicine/Cardiology at Northwestern Universitys Feinberg School of Medicine.

Making the right choice, the experts say, hinges on the physicians clear explanation and the patients correct understanding of the benefits and risks of statins as they pertain to that specific patient, not as an obscure statistical concept.

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To Statin or Not to Statin?