New guidelines expand advice on who should take statins

If you’re older than 40 and have certain risk factors for heart disease, you might need statins to prevent a stroke or heart attack. New guidelines published in the Journal of the American Medical Association are expanding recommendations on who should be taking cholesterol medications.

Traditionally, doctors would treat two groups of people with statin medication: those with cardiovascular disease and/or with diabetes, and those who had elevated cholesterol numbers. The recommendations are the same for the first group, but have changed for the group in which doctors looked at numbers alone.

The U.S. Preventive Task Force now suggests that we take a more comprehensive approach in determining who should be on statin medication. The new guidelines concluded that if all three of the following apply to you, then you should be on statin medication:

    • If you’re between 40 and 75 years old,
    • If you have one or more heart disease risk factors like high cholesterol, diabetes, high blood pressure, or smoking; and
    • If you have a calculated 10-year risk of having a cardiovascular event like a heart attack or stroke of 10 percent or greater.

You can determine your 10-year risk using this calculator developed by the American College of Cardiology and the American Heart Association. Basically, your risk is calculated based on the following:

  • Age — the older you are, the higher your risk
  • Gender — males are more at risk than females
  • Race— African Americans are most at risk
  • Cholesterol numbers
  • Blood pressure numbers
  • Whether you have diabetes
  • Whether you’re a smoker

A worrisome calculated risk is greater than 10 percent, but a risk greater than 7 percent also warrants a conversation with your doctor.

There are some side effects associated with statins, so it’s important to weigh the benefits and risks. Most people tolerate statins well, but some may have side effects such as muscle pain and weakness, digestive problems, high blood sugar and confusion. In rare cases they can cause liver problems. But side effects of heart attacks and strokes can be very serious, even fatal. Statins — and most importantly, a healthy lifestyle — can significantly reduce the risk of these serious events.

About the author

Cherese Wiley, MD
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Cherese Wiley, MD, is an internal medicine physician on the medical staff at Baylor University Medical Center at Dallas.

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New guidelines expand advice on who should take statins