The American College of Cardiology (ACC) and the American Heart Association (AHA) have issued a set of new guidelines for the use of cholesterol-lowering drugs simvastatin (Zocor), atorvastatin (Lipitor), rosuvastatin (Crestor), and others. These drugs are among our most important tools for preventing so-called cardiovascular events, including heart attacks, cardiac arrests, and strokes. Sales of Crestor–the top-selling statin–alone will exceed $5 billion dollars in 2013. Therefore, these new guidelines have attracted considerable attention and controversy.
What’s New and Controversial
The new guidelines suggest that patients at high risk of cardiovascular events should consider taking a statin, while also adhering closely to a heart-healthy lifestyle. That much isn’t controversial. The controversy lies in the way we define “high risk,” and in the way we monitor the effectiveness of statins. The new guidelines state that:
- If your chances of having a cardiovascular event at any time in the next 10 years is greater or equal to 7.5%, you’re considered “high risk.” Previously, the cutoff was 10%. Using this this new lower cutoff, many more people are going to be categorized as “high risk.” (We calculate your risk based on age, gender, blood pressure, and family history, among other factors.)
- Patients who take statins don’t need to have their cholesterol levels monitored over time. Simply taking the medication is all that matters; knowing how much it reduces your cholesterol levels is irrelevant.
Whether the general medical community will embrace these new guidelines remains to be seen. At One Medical Group, we’re working with experts at leading research centers around the country to help determine our own response, and we acknowledge that the topic is likely to remain highly controversial for several months or years. Please follow one:life for more updates, and book an appointment with your provider if you’d like to discuss the pros and cons of statin therapy based on the new guidelines.
About Statins and Lifestyle Interventions That Can Help
Meanwhile, here are some related issues to consider:
- Statins clearly reduce the risk of cardiovascular events in people with known cardiovascular disease (e.g., people who have already had a heart attack or stroke), or who have serious risk factors (e.g., diabetes).
- For everyone else, the benefit of taking a statin is much smaller.
- Statins are generally very safe, but can cause muscle aches and muscle inflammation in a small percentage of patients.
- Without question, the best way to reduce your risk of a cardiovascular event is to modify your lifestyle. Quitting smoking, exercising regularly, reducing stress, and losing weight are all remarkably effective. Recent evidence has shown a dramatic reduction in heart disease in people who switch to eating a Mediterranean diet.