En español l When two groups of heart experts announced in November a whole new way of using cholesterol-lowering statin drugs to reduce Americans' risk of heart attack and stroke, they triggered both scathing criticism from some physicians and medical researchers, and widespread confusion among patients.
Previously, doctors had prescribed statins based primarily on the numbers from your cholesterol blood test. If your numbers were too high and you were deemed at risk for heart problems, you probably were urged to take one of these popular drugs to bring the numbers down.
Because these guidelines hadn't been updated in about a decade, the government and a committee of cardiologists decided to look at newer research on statins' benefits, as well as the impact of other risk factors on heart disease. The committee announced its recommendations at last fall's annual meeting of the American Heart Association.
The new guidelines focused not on specific cholesterol numbers but on four broad categories of people at risk of having either a heart attack or stroke if they didn't take a statin (see sidebar at right). There were few complaints about the first three categories but an outburst of criticism over the last one. That group included people who hadn't been diagnosed with heart disease, but who had at least a 7.5 percent risk of having a heart attack or stroke within the next 10 years, based on the guidelines' new risk calculator, which takes into account age, race, gender and heart risks.
Some critics lambasted the calculator for overestimating a person's risk, saying it could result in millions of people unnecessarily being prescribed statins. Others questioned whether statins should even be prescribed to prevent heart disease in relatively healthy patients.
Meanwhile, patients have been bombarding doctors with some basic questions. Here are answers from some leading medical experts:
Should I be on a statin?
"If your only risk factor is your age, you may not need to be on a statin," said Michael Blaha, M.D., director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.
Harvard's John Abramson, M.D., author of Overdosed America, acknowledges that taking a statin can reduce your risk, but not by a lot. "Treating 140 people with less than a 20 percent risk for five years will prevent one heart attack or stroke." He favors focusing more on preventing a heart attack through lifestyle changes.
I'm already on a statin. Should I keep taking it?
Oluseyi Ojeifo, M.D., of the Ciccarone Center, hears this question a lot lately. Her advice: Talk to your doctor about "the risk factors that got you on a statin originally. Your numbers might be better (under the new guidelines), or your risk may be the same."
Should I worry about statins' side effects?
About 18 percent of people report a side effect to their doctor, says Abramson, "and there is evidence that older people have more side effects," including muscle aches, cognitive impairment, sexual dysfunction, increased risk of diabetes and liver dysfunction. "But if you're at high risk, you should fear a heart attack or stroke more than side effects," says Ojeifo.
She suggests some things you and your doctor can try. First, confirm that it's really the statin causing the problem. Stop the drug to see if your symptoms go away. Try a different dose or another type of statin. Consider changing how frequently you take the drug.
Aside from taking a statin, what else can I do to lessen my chances of developing heart problems?
Lifestyle changes are a critical component of reducing heart disease risk. That means following a heart-healthy Mediterranean diet (light on red meat, heavy on veggies, nuts, fish and olive oil) and getting regular physical activity.
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