U.S. Panel Urges Cholesterol-Lowering Statins for Some Adults Aged 40-75

For the first time, the U.S. Preventive Services Task Force has issued a recommendation on the use of cholesterol-lowering drugs known as “statins,” emphasizing that adults as young as 40 — without a previous heart attack or stroke — could benefit from low-to-moderate doses.

The task force said the medications will be of most benefit for people with a 10-percent risk of heart attack or stroke in the next 10 years. Even some individuals with a risk as low as 7.5 percent should start taking the drugs, depending on individual diagnoses. Risk factors for heart disease include high cholesterol, high blood pressure, diabetes or smoking. A 10-year risk is calculated using these and other factors, such as gender and family history.

The panel’s recommendations stir a new debate over the use of statins, which generally lower cholesterol levels by about 25 to 35 percent. However, statins have long been recommended for people who already have heart disease. The bigger question that physicians must address is whether statins should be used to prevent heart disease in the first place, and whether lifestyle changes — including a healthier diet, regular exercise and weight management — are sufficient to prevent heart disease.

“People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke. Fortunately, for certain people at increased risk, statins can be very effective at preventing these events,” said Task Force member Douglas K. Owens, M.D., in a statement.

‘A low- to moderate-dose’

The task force says that doctors may choose to offer “a low- to moderate-dose statin” to certain adults without a history of heart disease when all of the following criteria are met:

• They are ages 40 to 75 years.
• They have one or more heart disease risk factors (i.e., high cholesterol, diabetes, hypertension, or smoking).
• They have a calculated 10-year risk of a cardiovascular event of 7.5 percent to 10 percent.

The task force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The recommendation is in draft form and will become final after a public comment period. Comments can be submitted through Jan. 25 via the task force website.

The task force recommendations are based on analysis of existing data from 18 randomized controlled trials. These trials compared statin use among people without previous heart attacks and strokes to people taking dummy pills or nothing at all.

“But it’s not just about cholesterol,” stresses Jonathan Fialkow, M.D., medical director of clinical cardiology at Miami Cardiac & Vascular Institute. “There is much more involved in looking at one’s health, including obesity, diabetes and family history. These guidelines are less focused on cholesterol levels before and after treatment.”

The task force also says that “all adults can reduce their risk of cardiovascular disease by not smoking, eating a healthy diet, engaging in physical activity and limiting alcohol use.”

Many physicians question whether the potential side effects from statins — including a higher risk for diabetes — are worth it for lower risk patients. Nonetheless, the task force recommendations are similar to new guidelines issued in 2013 by the American Heart Association (AHA) and American College of Cardiology.

Obesity, Diabetes and Other Risk Factors

The 2013 guidelines for preventing heart disease and stroke also focus on obesity, diabetes and other risk factors, while not focusing solely or too much on cholesterol levels. Measuring cholesterol is still a vital component. The guidelines effectively broadened the formula for evaluating who needs to take statins. The intended end result: More people in need of statins will get them. The updated guidelines treat obesity as a disease and provide other resources to treat risk factors, such as diabetes and high blood pressure.

“We’re targeting the people who are at much higher risk for heart disease or stroke at an earlier point in their lives,” says Dr. Fialkow. “Earlier treatment improves the chances of avoiding problems.”

The Task Force found that the current evidence is “insufficient to assess the balance of the benefits and harms of statin use” for the prevention of cardiovascular disease in adults 76 years and older.