HEALTH: People over 40 should take statins regardless of heart disease history — surprising new guidelines

Even people with no history of heart disease should consider taking statins.

That is the sweeping new recommendation released by the U.S. Preventive Services Task Force on Sunday.

The new guidelines greatly widen the recommended pool of patients for the cholesterol-reducing drugs to anyone over 40 with one of these risk factors: high cholesterol, high blood pressure, diabetes or a smoking habit.

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

Expanding the pool of potential statin patients is good news for pharmaceutical companies, considering some 39.2 million Americans were already using statins in 2013, JAMA Cardiology reported Monday.

Statins, which include Lipitor, Crestor and Zocor, were introduced in the 1990s to reduce LDL, or “bad,” cholesterol. They have been proven to reduce heart attacks and death from cardiovascular disease in vulnerable subjects, and so statin use has spiked 79% in the 10 years between 2002-2003 and 2012-2013.

But even as cardiovascular-related deaths continue to drop, heart disease remains the number one killer across the globe, and claims 1 in 3 American adults each year. Some cardiologists aren’t convinced that statins are the single magic bullet to save lives.

“There is no other medication that is more controversial when it comes to my patients than statins," said Dr. Suzanne Steinbaum, director of Women’s Heart Health at Lenox Hill Hospital.

Not everyone can tolerate statins. Side effects commonly include muscle pain and weakness, and there is some increased risk of certain types of stroke and diabetes, as well as decreased brain function, tendon rupture and lung disease.

Dr. Steinbaum agreed that there is “absolutely a role for statins,” especially in patients who have suffered heart attack or stroke, or received stents to open narrowed arteries. But that’s only part of the equation. “If we don’t put emphasis on lifestyle modifications, if we instead just put emphasis on statins, we’re making a big mistake,” she said. “One does not work without the other.”

 

She’s backed by a new study out of the Center for Human Genetic Research at Massachusetts General Hospital this week, which found that while your genes can double the risk of heart disease, a heart-healthy lifestyle that includes not smoking, exercising moderately and eating lots of fruits, vegetables, fish and grains slashes that risk in half. And on the flip side, an unhealthy lifestyle where one might smoke, eat junk food and be sedentary negates about half of the benefits you get from good genes.

"We've known that modifying risk factors could have an impact on health, but this is the first to show you could have a 50% reduction in heart disease," said Dr. Roxana Mehran at the Icahn School of Medicine at Mount Sinai, who worked on the lifestyle study. "I'm hoping that now we're going to see more people running around the Central Park Reservoir."

Added Dr. Steinbaum, “Focusing on lifestyle interventions would be an incredible way to cut back on costs in the health care system."

The U.S. gross domestic product-adjust cost for statins ran $16.9 billion in 2012-2013, according to JAMA Cardiology. That averaged about $94 a year for people out-of-pocket, although Dr. Steinbaum noted that patients taking name-brand designer drugs can shell out $200 to $250 a month.

And with President-elect Trump vowing to dismantle the Affordable Care Act in 2017, the health insurance status of many Americans is suddenly uncertain.

Plus, taking statins lowers cholesterol, but doesn’t treat an unhealthy diet, sedentary lifestyle or a smoking habit. “The answer to all of these risk factors isn’t just, ‘Take this drug,’” said Dr. Steinbaum. “We’ve got to figure out how to live a heart-healthy life. That is the answer.”

Problem is, we can't trust ourselves to take care of ourselves.

"Modifying your lifestyle risk factors is the best way to go, but is everyone going to get out there and do that? We know they're not," said Dr. Mehran. "So if you're over 40 and  you have some risk factors, you're probably better off taking a mild to moderate dose of statins to protect yourself.