News ID: 260471
Published: 1002 GMT October 20, 2019

Statins may not be necessary for people with lower heart disease risk

Statins may not be necessary for people with lower heart disease risk

Taking the “better safe than sorry” approach with cholesterol drugs may no longer be the best way to slow heart disease.

Statins — including cholesterol-lowering medications such as Lipitor, Mevacor, Crestor, and Zocor — may not be as helpful as once believed for people in low to moderate risk categories, according to a new studyTrusted Source from the UK, wrote.

Researchers at the National University of Ireland Galway concluded that statins as primary prevention against heart disease “may be an example of low value care and, in some cases, represent a waste of health care resources.”

Statins are drugs that lower the level of cholesterol in the blood by blocking the enzyme in the liver responsible for producing cholesterol.

According to the researchers, statins are among the most frequently used drugs in the world, accounting for global sales that will approach $1 trillion by 2020.

The study doesn’t challenge the use of statins by those who already have a diagnosis of heart disease, only for healthy older adults.


Who should take statins?


The guidelines around who should take statins have changed over the years.

In Ireland, the 1987 guidelines put about eight percent of people 50 or over eligible for the drugs. By 2016, that number increased to 61 percent, the researchers reported.

The new study suggested people classified as low or moderate risk for cardiovascular disease wouldn’t reach acceptable cholesterol risk levels to justify taking statins.

The study authors said the use of statins in these people “warrants more careful consideration,” and that the concepts of overuse and low value care “should become integral to policy making and resource allocation decisions.”

Some experts pointed out that in the US, medical guidelines say the benefit of using statins in people with a low or medium risk really isn’t always justified.

“The current American College of Cardiology guidelines for statin use emphasize collaborative decision-making between providers and patients,” Tomas Ayala, MD, FAAC, a cardiologist at Mercy Medical Center in Baltimore, Maryland, told Healthline.

“In general, statins are not recommended for low-risk patients. For patients at high risk… statins are recommended for primary prevention of cardiac events. For those of immediate risk, statins are recommended only if the patient also has a high-risk illness, such as diabetes, peripheral vascular disease, or cerebrovascular disease.”

“So, as you see, the current recommendations are really in line with what’s being described,” Ayala said.


Evaluating the risks


In the US, there’s been past research indicating there are potential risks for some people taking statins.

“There has been an ongoing debate and multiple studies about this for the past five to 10 years now,” Felecia Sumner, DO, a family practitioner in Lansdowne, Pennsylvania, told Healthline.

“We already know that statins can cause some serious side effects, such as muscle damage or pain, increased blood sugar, neurological problems such as memory loss, and sexual dysfunction, just to name a few,” she said.

“We also have found that approximately 70 percent of people with heart attacks end up having normal cholesterol levels,” Sumner added. “There is much more to this story, such as sleep, stress, inflammation, etc.”

That doesn’t mean the most recent study wasn’t beneficial, notes Alam Hallan, the director of pharmacy at Guelph General Hospital in Ontario, Canada.

But the more people are prescribed statins, the more likely harmful side effects will appear.

“The authors are saying we need to change the way we look at numbers showing benefit, and also start to consider harm,” Hallan told Healthline.

“I agree. The way we present risk to patients matters, and the shift toward taking into consideration absolute risk reduction versus related risk reduction and patient opinion will certainly reduce the prescribing of statins.”

The risks aren’t just in the math, added Kunal Domakonda, MD, FAAC, a cardiologist in Hamden, Connecticut, although statins still remain the best hope for many.

“The US has a large population of people who have diabetes, hypertension, and elevated cholesterol,” Domakonda told Healthline.

“Death from heart disease remains the number one killer of Americans, unfortunately. Statins are one of the tools in the toolbox.”

“Not everyone who is prescribed a statin can tolerate the medication,” he continued.

“There are side effects to be aware of and, in rare instances, this medication can cause damage to the muscles as well as the liver. Close monitoring during initial dosing is recommended by a healthcare professional.”


Considering the benefits


The possible benefits of statins depend on whose being treated, said Anuj Shah, MD, a cardiologist in Passaic, New Jersey.

“Studies suggest that we can save one incidence of heart attack for every 217 [low risk] patients treated [with] statins for primary prevention,” Shah told Healthline. “Statins are the most commonly prescribed medication, and they certainly have a lot of proven benefits, definitely outweighing harm in the right population.”

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