Millions more Americans could end up taking cholesterol-lowering statin drugs under new recommendations released Tuesday that advocate a dramatic shift in the way doctors assess and treat cardiovascular risk.
Roughly a quarter of Americans age 45 and older already take statins, which include familiar brands such as Lipitor and Zocor, to treat high cholesterol. But that number could grow sharply under far-reaching guidelines detailed by the American Heart Association and the American College of Cardiology.
At the core of the recommendations, which resulted from a four-year review of medical research, lies a new formula intended to help physicians calculate the chances of heart attacks and stroke in patients, particularly those in certain risk categories.
That represents a sea change from the approach that has persisted for more than a decade, of focusing intently on the level of a patient’s low-density lipoproteins (LDL) — the “bad cholesterol.”
Instead, the new guidelines encourage doctors to consider age, weight, blood pressure and other factors, such as whether patients smoke or have diabetes. If a person appears to have even a moderate risk of a heart attack or stroke, he or she should be prescribed statins, regardless of LDL score.
“It’s really about your global risk,” said Donald Lloyd-Jones, chair of the Department of Preventive Medicine at Northwestern University and one of 20 experts on the committee that wrote the new guidelines. “There were a number of people at substantial risk who, under the old paradigm, were not being captured.”
Heart disease remains the nation’s leading killer of men and women. About one in every four deaths in the United States, or about 600,000 annually, are attributed to heart disease, according to the Centers for Disease Control and Prevention. More than 700,000 Americans suffer heart attacks each year, and the costs of coronary heart disease — from health care to lost productivity — exceed $100 billion annually, the agency has said. In addition, strokes kill another 130,000 people a year.
The new recommendations call for prescribing statins to an estimated 33 million Americans who don’t have cardiovascular disease but who have a 7.5 percent or higher risk for a heart attack or stroke over the next decade. Examples of groups that could fall into that category include white women over 60 who smoke and African American men over 50 with high blood pressure.
Roger Blumenthal, director of the Ciccarone Preventive Cardiology Center at Johns Hopkins University, said about 50 or 60 percent of African American men and a third of white men in their 50s probably will qualify for treatment under the new regime. African American men tend to have higher blood pressure than their white counterparts. Similarly, a majority of black women in their 60s and a third of white women the same age are likely to end up on the medications, along with most men in their 70s and older.
That doesn’t mean every man over 70 will be put on statins, said Blumenthal, who represents the American College of Cardiology on a committee at the National Institutes of Health that is helping to foster the adoption of the new guidelines. Primary-care physicians and cardiologists will use the guidelines as a starting point in treating their patients. But overall, the doctors said they expect a significant increase in the number of people taking statins, and a decrease in the use of other drugs that are prescribed along with them in an attempt to lower LDL levels.
Roughly a quarter of Americans age 45 and older already take statins, which include familiar brands such as Lipitor and Zocor, to treat high cholesterol. But that number could grow sharply under far-reaching guidelines detailed by the American Heart Association and the American College of Cardiology.
At the core of the recommendations, which resulted from a four-year review of medical research, lies a new formula intended to help physicians calculate the chances of heart attacks and stroke in patients, particularly those in certain risk categories.
That represents a sea change from the approach that has persisted for more than a decade, of focusing intently on the level of a patient’s low-density lipoproteins (LDL) — the “bad cholesterol.”
Instead, the new guidelines encourage doctors to consider age, weight, blood pressure and other factors, such as whether patients smoke or have diabetes. If a person appears to have even a moderate risk of a heart attack or stroke, he or she should be prescribed statins, regardless of LDL score.
“It’s really about your global risk,” said Donald Lloyd-Jones, chair of the Department of Preventive Medicine at Northwestern University and one of 20 experts on the committee that wrote the new guidelines. “There were a number of people at substantial risk who, under the old paradigm, were not being captured.”
Heart disease remains the nation’s leading killer of men and women. About one in every four deaths in the United States, or about 600,000 annually, are attributed to heart disease, according to the Centers for Disease Control and Prevention. More than 700,000 Americans suffer heart attacks each year, and the costs of coronary heart disease — from health care to lost productivity — exceed $100 billion annually, the agency has said. In addition, strokes kill another 130,000 people a year.
The new recommendations call for prescribing statins to an estimated 33 million Americans who don’t have cardiovascular disease but who have a 7.5 percent or higher risk for a heart attack or stroke over the next decade. Examples of groups that could fall into that category include white women over 60 who smoke and African American men over 50 with high blood pressure.
Roger Blumenthal, director of the Ciccarone Preventive Cardiology Center at Johns Hopkins University, said about 50 or 60 percent of African American men and a third of white men in their 50s probably will qualify for treatment under the new regime. African American men tend to have higher blood pressure than their white counterparts. Similarly, a majority of black women in their 60s and a third of white women the same age are likely to end up on the medications, along with most men in their 70s and older.
That doesn’t mean every man over 70 will be put on statins, said Blumenthal, who represents the American College of Cardiology on a committee at the National Institutes of Health that is helping to foster the adoption of the new guidelines. Primary-care physicians and cardiologists will use the guidelines as a starting point in treating their patients. But overall, the doctors said they expect a significant increase in the number of people taking statins, and a decrease in the use of other drugs that are prescribed along with them in an attempt to lower LDL levels.