Study Suggests Fewer People Might Need Statins for Heart Disease Prevention

A new method for assessing heart disease risk might lead to fewer people being prescribed statins, according to recent research. However, heart specialists emphasize that more data is required, and patients should not discontinue their medications prematurely.

Statins, including Lipitor, Crestor, and Zocor, are commonly prescribed to manage high LDL cholesterol levels, a key factor in cardiovascular disease. The current prescribing guidelines from the American Heart Association and the American College of Cardiology, established in 2013, factor in age, diabetes, blood pressure, and other elements to estimate risk.

In the study led by Dr. Tim Anderson from the University of Pittsburgh, researchers evaluated the impact of a new heart disease risk calculator called PREVENT, introduced by the American Heart Association last year. The analysis included data from 3,785 adults aged 40 to 75 from the National Health and Nutrition Examination Survey (NHANES), comparing the new calculator’s estimates to those of older guidelines.

The PREVENT calculator aims to provide a more precise risk assessment by including newly identified risk factors such as kidney disease and obesity.

The study found that the 10-year heart disease risk calculated with PREVENT was roughly half of that estimated by the previous tool. As a result, around 40% fewer individuals would qualify for a statin prescription under the new calculations, potentially affecting up to 4 million Americans currently on statins for primary prevention (preventing a first cardiovascular event like a stroke or heart attack).

How Does the New Calculator Differ?

The new tool:

• Omits race from the equation, using ZIP code instead to indicate socioeconomic status.
• Includes additional risk factors such as kidney disease, obesity, and hemoglobin A1C levels (a marker of blood sugar control).
• Separately calculates risk for men and women.

Anderson suggests that these findings should encourage patients on statins for primary prevention to consult their doctors about whether they need to continue the medication, especially considering statins’ side effects like muscle pain, headaches, sleep disturbances, and digestive issues.

“For patients on the borderline, it’s crucial to discuss with their physician, as family history and other unaccounted factors might still justify statin use,” Anderson noted.

Cardiovascular experts voiced concerns that the new study might lead some patients to stop taking their medications prematurely. They stressed the need for new guidelines to accompany the new risk calculator.

“Risk models inform recommendations, but guidelines ultimately determine who should take statins,” said Dr. Sadiya Khan, chair of the PREVENT development committee and a professor at Northwestern University’s Feinberg School of Medicine. “The critical question of when to recommend starting statins remains undecided.”

Dr. Robert Rosenson from the Mount Sinai Health System warned that the study’s small participant pool wasn’t representative of the broader U.S. population, highlighting the need for caution.

“The claim that fewer patients should be eligible for statins is based on a limited sample from the NHANES database, which is concerning,” Rosenson said.

Dr. Shaline Rao from NYU Langone Hospital-Long Island expressed worries that patients who genuinely need statins might misinterpret the study’s findings.

“We see significant benefits of statins across diverse populations,” Rao emphasized.