A Times Editorial

Editorial: Guidelines on statins need review

New medical guidelines from the nation’s leading heart associations that challenge the status quo on the use of statins to lower cholesterol deserve a hard second look. The American College of Cardiologists and the American Heart Association should thoroughly review their online risk calculator that was rolled out last week to determine whether the results users get reflect the best science or overstate the health risk. A well-intentioned effort to help Americans be more health conscious loses credibility if its results are skewed.

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New medical guidelines from the nation’s leading heart associations that challenge the status quo on the use of statins to lower cholesterol deserve a hard second look. The American College of Cardiologists and the American Heart Association should thoroughly review their online risk calculator that was rolled out last week to determine whether the results users get reflect the best science or overstate the health risk. A well-intentioned effort to help Americans be more health conscious loses credibility if its results are skewed.

New medical guidelines from the nation's leading heart associations that challenge the status quo on the use of statins to lower cholesterol deserve a hard second look. The American College of Cardiologists and the American Heart Association should thoroughly review their online risk calculator that was rolled out last week to determine whether the results users get reflect the best science or overstate health risks. A well-intentioned effort to help Americans be more health-conscious loses credibility if its results are skewed.

For years, a statins prescription has been the medical standard for patients with high "bad" LDL cholesterol that can't be controlled by diet or exercise. One in four Americans over 40 years old have a prescription for the drug, which inhibits the production of enzymes necessary for the production of the bad cholesterol that can contribute to plaque in the arteries. But such conventional treatment may be out the window for some patients.

After a five-year review, the new standard eliminated guidance on acceptable bad cholesterol levels. That means it is no longer recommended for doctors to prescribe statins for patients who were only on the drugs to lower their bad cholesterol. The team writing the standard said the data don't exist to determine what level of bad cholesterol is desirable for preventing heart disease — or whether chemically reduced bad cholesterol levels have the same benefit as lower levels that come as a result of better diet and exercise.

But if some patients would no longer be advised to take statins, the more dramatic change under the guidelines is that many more people could be deemed candidates for the drug's use. A new risk calculator produced as part of the recommendations appears to frequently overpredict which individuals have a risk of heart attack in the next 10 years. Critics, including a pair of Harvard Medical School professors, suggest the calculator is inflating by as much as 150 percent an individual's risk of heart attack. They fault the research behind the calculations — medical data from an era when more people smoked, women were significantly less likely to suffer heart attacks than men and people suffered heart attacks and strokes at younger ages.

The upshot, as explained by the New York Times, is a man with a 4 percent risk of a heart attack in the next decade might show up as having an 8 percent risk — putting him well-above the 5 percent threshold where treatment is considered and the 7.5 percent where it is advised. The result could be a powerful prescription he doesn't really need.

The kind of examination of standard medical practice that the heart associations undertook is just the kind of discussion that needs to happen across the medical community as the country seeks to move from fee-based to outcome-based practices. But replacing one standard that led 1 in 4 Americans over 40 to be prescribed a drug with a guideline that potentially even more should receive the drug feels, even to the layperson, like overmedication. The groups have said they will take a second look and they should invite their critics to help them. That's good. Americans' health is at stake.

Editorial: Guidelines on statins need review 11/18/13 [Last modified: Monday, November 18, 2013 5:44pm]

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