Millions more could get statin drugs

Rules don’t fixate on cholesterol numbers

Just less than half of all people ages 40-75 would be eligible for statin drugs under new guidelines designed to help doctors prescribe the cholesterol-lowering therapies.

A study published Wednesday by the New England Journal of Medicine found that the guidelines, released in November, would add nearly 13 million people to those already receiving or eligible for statins. Among people age 60-75, 87% of men (up from 30% now) and 53% of women (up from 21% now) should take statins if they aren’t already, the analysis found.

Basically, the guidelines imply “if you’re a 60- to 75-year-old man and not on a statin, you should go get one, and every other woman of this age should get one,” said Michael Pencina, director of biostatistics at the Duke Clinical Research Institute in Durham, N.C. Pencina led the new study, which examined data from more than 3,700 people nationwide.

When the guidelines were released in November by the American College of Cardiology and the American Heart Association — moving away from cholesterol numbers as the driving force behind statin prescriptions — there was an uproar from cardiologists. Wednesday marked the first time that anyone quantified the changes the guidelines might bring.

“If our goal is to help people feel better, live longer and have less heart disease, putting millions more on statins is not going to do that.” Rita Redberg, a cardiologist at the University of California- San Francisco.

Cardiologists are united in believing that statins work extremely well for people who’ve already had a heart attack or stroke, reducing plaque buildup in blood vessels and making that plaque less likely to rupture. But there is active debate about whether so many people without overt heart disease should be given statins.

“If our goal is to help people feel better, live longer and have less heart disease, putting mil- lions more on statins is not going to do that,” said Rita Redberg, a cardiologist at the University of California-San Francisco. Healthier lifestyles will do that, she said, citing diet, exercise and smoking cessation. “I think that’s what our guidelines should be focusing on.”

Only 2%-3% of those without a previous heart attack or stroke will see any benefit, said Eric Topol at Scripps Health in San Diego. Those who wrote the guidelines, he said, got “carried away with a very minor benefit.”

Neil Stone, chairman of the guidelines committee, said they were intended to spark discussion between doctors and people older than 40 at risk for heart attack and stroke.

“We think medicine should be more personalized based on evidence and the person’s characteristics,” Stone said.