Thursday, November 14, 2013

Statins Part 2

     Recently, the American Heart Association and the American College of Cardiology came out with new recommendations for the use of statins. As always, there was no minority report, and some physicians quit the advisory panel because they could not agree with the final recommendations. The important point is that the new recommendations look at patients as more than just their cholesterol numbers.

     The recommendations are quite simple. There is a recommendation for the use of statin therapy based on the patient's medical condition, and there is NO target number to which the total cholesterol or LDL cholesterol should be lowered. Also, Zetia is never recommended since there is no evidence that Zetia, despite lowering cholesterol, can lower the heart attack or stroke risk. There is something that statins do, perhaps related to their anti-inflammatory effect, that does lower these two risks.

     The first recommendation is an emphasis on the Mediterranean diet, which involves increasing one's intake of vegetables, fruits, and whole grains, low fat dairy products, poultry, fish, legumes and nuts, and limiting the intake of sweets, saturated fats, and trans fats.

     High intensity statin therapy is recommended for individuals who have ASCVD and are younger than 75 years, and for those who have had a heart attack. The importance, again, is in prescribing statins, and not aiming for a target number for total cholesterol or LDL cholesterol. Just giving a statin seems to be sufficient to give protection.

     If high intensity statins cannot be tolerated because of muscle cramps, etc., then the dose should be lowered, but in this high risk group, a statin is mandatory.

     If your LDL cholesterol is 190 or higher, then again high dose statin therapy is recommended for any age group.

     If you have diabetes, then moderate intensity statin therapy is recommended between the ages of 40 and 74.

     Using tables which are available in the literature, if your 10 year ASCVD risk is 7.5% or more, and you are between the ages of 40 and 75, then you should be given moderate or high dose statin therapy.

     The overall message is that if you are at risk for a heart attack you should be taking a statin at as high a dose that can be tolerated. Again, the target numbers for cholesterol and LDL cholesterol are no longer used (except that an LDL cholesterol of over 190 should be treated). No longer should an attempt be made to get the LDL down to 70 or 100, etc.