Study suggests that fewer and fewer people need an anti-cholesterol drug to avoid heart problems

A novel way to determine heart disease risk could free millions of Americans from needing statins, according to a new study. However, cardiologists caution that more information is needed and that patients should not stop taking their medications.

Statins, such as Lipitor, Crestor and Zocor, are widely used to protect against elevated levels of LDL cholesterol, one of the causes of cardiovascular diseases. Doctors prescribe daily pills based on 2013 guidelines from the American Heart Association and the American College of Cardiology, which estimate risk based on age, diabetes, blood pressure and other factors.

For the new study, Dr. Tim Anderson, an assistant professor of Medicine at the University of Pittsburgh, and his colleagues analyzed the potential impact of a new heart disease risk calculator, called PREVENT, which was introduced by the American Heart Association. last year. Using data from 3,785 adults ages 40 to 75 who participated in the National Health and Nutrition Survey (NHANES), the researchers compared the new calculator's estimates to previous guidelines.

The association's new calculator was developed to offer a more precise evaluation of a person's likelihood of developing heart disease, incorporating recently recognized risk factors such as kidney disease and obesity.

Researchers found that among participants, the 10-year risk of developing heart disease estimated with the new tool was about half that estimated with the old one, according to the report published Monday in JAMA Internal Medicine.

Using PREVENT to estimate the 10-year risk of heart disease, the researchers determined that about 40% fewer people would have met the criteria for statin prescription.

In other words, up to 4 million people in the United States who are currently taking statins preventively (that is, who have not suffered a cardiovascular event such as a stroke or myocardial infarction) they might not need themaccording to Anderson, lead author of the new study.

How is the new calculator different?

Among other factors, the new tool:

  • It removes race from the calculation, replacing it with the person's ZIP code, which serves as an indicator of socioeconomic status.
  • It includes factors that can increase the risk of heart disease, such as kidney disease, obesity, and an indicator of poor blood sugar control (hemoglobin A1C).
  • Calculate the risk separately for men and women.

According to Anderson, the new results give people who take statins preventatively the opportunity to ask their doctor if they need to continue taking the medicine. Although it is important to treat heart disease risks before a first episode occurs, statins can cause side effects in some people, such as muscle pain, headaches, sleep problems, and digestion problems.

“Patients who are right on the borderline need to know that there are other factors that these calculators don't include, such as family history, so it's very important to talk about that with your doctor,” Anderson said.

Cardiovascular disease experts are concerned that the new study could convince some patients to stop taking their medicationsespecially considering that many people no longer take them against the advice of their doctors.

According to Dr. Sadiya Khan, chair of the PREVENT development committee and professor of Cardiovascular Epidemiology at Northwestern University Feinberg School of Medicine, the new risk calculator will need to be accompanied by new guidelines.

“Risk models do not determine who is recommended to take statins, but guidelines do,” Khan explained. “I think the most important thing is to determine when it will be recommended to start the use of statins. “That hasn’t been decided yet.”

Dr. Robert Robinson, director of lipids and metabolism at Mount Sinai Health System in New York, cautioned that the small number of participants in the study was not representative of the U.S. population.

“Their main point, that fewer patients should be eligible for statins, is based on a limited number of people in the NHANES database,” Robinson said. “That is alarming.”

Dr. Shaline Rao, director of heart failure services at NYU-Long Island Langone Hospital, worries that patients who really need cholesterol drugs may be getting the wrong message.

We see many benefits of statins in many towns,” he stressed.