In November 2013, the American Heart Association and the American College of Cardiology issued their long-awaited update regarding the prevention of cardiovascular disease and the use of prescription statin drugs. The 84-page report, considered an improvement over the decade-old previous guidelines, relies upon evidence from large clinical trials—not available even 10 years ago. Some observers, however, may consider these changes both drastic and controversial.
A condensed version of the controversy includes an increased use of more potent, higher dose statins as a first-line of defense, while all but abandoning other cholesterol-lowering drugs such as Zetia and Lopid. The scope of who should take those potent statins has also oadened.
Statins—such as Lipitor, Mevacor, Crestor, and Zocor—are already commonly prescribed. Approximately 15 percent of U.S. adults now take those drugs. Most likely, those patients got on these drugs by having a cholesterol level well above 200. The major focus of care was to get that number below 200.
The new guidelines stress the importance of simply getting on the drugs; especially for those not only with high cholesterol numbers, but also those with LDL levels higher than 190, people with type-2 diabetes (who are aged 40 to 75), and those with a calculated risk of heart disease. These new guidelines could up the prescriptions ante to 30 percent of the population.
Let’s do the math—Duke University did. The online version of New England Journal of Medicine published Duke’s tallies in March 2014. According to their research, almost half of Americans aged 40 to 75 and nearly all men over the age of 60 could potentially be taking statins. That’s 56 million people versus 43 million under the previous recommendations. —S.H.
Thanks to Dr. William C. Maxted, Jr., of Cardiology Associates, for his help with this topic.
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