Despite national guidelines indicating that statins can lower risk of heart attack and stroke, many patients who could benefit do not take them. More than half of eligible patients say they were never offered the cholesterol-lowering drugs; the experience of side effects or fear of side effects were reasons for stopping or refusing statins, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.
Statins lower the amount of low-density lipoprotein (LDL, or “bad” cholesterol) and have been shown to lower the risk of heart attack and strokes. Because statins are proven effective and have a low risk of side effects, guidelines from the American Heart Association/American College of Cardiology recommend doctors use an atherosclerotic and cardiovascular disease risk calculator to give a detailed assessment of a person’s 10-year risk for heart disease and to help create a personalized plan.
The cholesterol-lowering drugs called statins have demonstrated substantial benefits in reducing the risk of heart attacks and strokes caused by blood clots (ischemic strokes) in at-risk patients. Since statins are associated with a low risk of side effects, the benefits of taking them outweigh the risks, according to a scientific statement from the American Heart Association that reviewed multiple studies evaluating the safety and potential side effects of these drugs. It is published in the Association’s journal Circulation: Arteriosclerosis, Thrombosis and Vascular Biology.
According to the statement, one in four Americans over the age of 40 takes a statin drug, but up to 10 percent of people in the United States stop taking them because they experience symptoms that they may assume are due to the drug, but may not be.
“In most cases, you should not stop taking your statin medication if you think you are having side effects from the drug — instead, talk to your healthcare provider about your concerns. Stopping a statin can significantly increase the risk of a heart attack or stroke caused by a blocked artery,” said Mark Creager, M.D., former president of the American Heart Association and director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
The U.S. Preventive Services Task Force (USPSTF) has issued a recommendation statement regarding the use of statins for primary prevention of cardiovascular disease in adults. The report appears in the November 15 issue of JAMA.
The USPSTF recommends initiating use of low- to moderate-dose statins in adults ages 40 to 75 years without a history of cardiovascular disease (CVD) who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10 percent or greater (B recommendation, indicating that there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial).
A major review of the available evidence on the safety and efficacy of statin therapy, published inThe Lancet, intends to help doctors, patients and the public make informed decisions about the use of the drugs. The authors warn that the benefits of statin therapy have been underestimated, and the harms exaggerated, because of a failure to acknowledge properly both the wealth of evidence from randomised trials and the limitations of other types of studies.
Research on statins has been ongoing for over 30 years, generating a large amount of data from a wide variety of patients. The review published today explains how the available evidence on the efficacy and safety of statin therapy should be interpreted, and concludes that:
A period of intense debate about statins, covered widely in the mainstream media, was followed by a substantial rise in the proportion of people in the UK stopping taking the drug, according to a new study by the London School of Hygiene & Tropical Medicine.
Led by the London School of Hygiene & Tropical Medicine and funded by the British Heart Foundation, the study by Anthony Matthews and colleagues is the first to attempt to quantify how the controversy questioning the risk-benefit balance for statins, reflected by the UK media, may have affected the use of the drug in primary care.
The researchers found no evidence that widespread media coverage of the debate was linked to changes in the proportion of newly eligible patients starting statins, but there was an increase of existing users stopping statin therapy.
The results of “The Japan Statin Treatment Against Recurrent Stroke (J-STARS)” study led to the hypothesis that statins reduce the occurrence of strokes due to larger artery atherosclerosis.
J-STARS examined whether pravastatin, a traditional statin widely used in the clinic, reduces the recurrence of strokes and respective subtypes in non-cardioembolic stroke patients. The study also examined whether the use of pravastatin favorably impacts the occurrence of other vascular events, and stroke-related functional outcomes were explored.
Statins are widely used to reduce cholesterol levels in blood. High cholesterol levels are associated with cardiovascular diseases such as strokes, so statins are thought to be beneficial for stroke prevention. However, these findings are obtained from patients without prior stroke, and the preventive effect is less robust in patients with prior stroke.
The use of statins for primary prevention in patients without vascular disease older than 79 increased between 1999 and 2012, although there is little randomized evidence to guide the use of these cholesterol-lowering medications in this patient population, according to a research letter published online by JAMA Internal Medicine.
Michael E. Johansen, M.D., M.S., of Ohio State University, Columbus, and Lee A. Green, M.D., M.P.H., of the University of Alberta, Canada, investigated the use of statins among this population by vascular disease because the very elderly have the highest rate of statin use in the United States, according to the study.
Discontinuing statin use in patients with late-stage cancer and other terminal illnesses may help improve patients’ quality of life without causing other adverse health effects, according to a new study by led by researchers at the University of Colorado Anschutz Medical Campus and Duke University and funded by the National Institute of Nursing Research (NINR).
The finding, to be published in JAMA Internal Medicineon March 23, indicates that care for patients with advanced illness can be improved by discontinuing some therapies that are primarily preventive for other health concerns.
“There is an increasing evidence base that discontinuation of some therapies may be beneficial for selected patient populations,” the authors write. Jean Kutner, MD, MSPH, professor of medicine at the University of Colorado School of Medicine, is the first author of the research study and Amy Abernethy, MD, PHD, of the Center for Learning Health Care at the Duke Clinical Research Institute, is the corresponding author.