New draft recommendations from the U.S. Preventive Services Task Force (USPSTF) propose low to moderate doses of statins to prevent first-time heart attack or stroke in high-risk adults ages 40 to 75.
According to the preventive medicine experts sitting on the independent panel, statins can provide maximum prevention to the said age group with at least one risk factor for heart disease and a minimum of 10 percent heart attack or stroke risk within the next decade.
The draft recommendations released Monday are deemed close enough to controversial 2013 guidelines from the American Heart Association as well as the American College of Cardiology. These 2013 guidelines promoted statin use in those ages 40-75 whose 10-year risk is 7.5 percent or higher – making millions more in America eligible for the drugs than previous recommendations.
Statin drugs such as Lipitor, Zocor, and Crestor are standard treatment for lowering cholesterol levels, working through curbing the substance’s production in the liver. While long recommended for heart disease patients, the use of these medications to prevent heart disease in the first place is still widely discussed and debated.
The panel, for instance, said healthcare providers should offer statins to 40 to 75 year old adults who have high cholesterol, smoke, or suffer from diabetes or hypertension, and have at least 10 percent heart attack or stroke risk over the next decade.
However, it leaves the weighing of pros and cons to patients who are not as high-risk. “[T]he likelihood of benefit is smaller due to a lower probability of disease and uncertainty in individual risk prediction,” the draft reads.
As for individuals over age 75, the task force noted there is insufficient proof that they will benefit from statins for heart disease protection.
It also endorsed using the online calculator found on the AHA website, where doctors enter information such as the patient’s age, sex, health conditions, and race along with LDL or bad cholesterol level. This calculator sparked controversy since its birth, with some saying it overestimates risks.
Current research also highlights the importance of looking at the combination of these factors rather than stand-alone figures, such as LDL level alone, when deciding who qualifies for statin use.
Dr. Donald Lloyd-Jones of Chicago’s Northwestern University said the new draft recommendations are extremely aligned with the 2013 guidelines they put out as AHA and ACC.
"It's a strong endorsement for the approach we took in the guidelines," he told a news publication.
Dr. Seth Martin of Johns Hopkins lauded the language of the recommendations in promoting shared decision-making. "We don't need more recommendations but, rather, better harmonized recommendations within and outside the United States," he said.
Since determining risk involves cholesterol levels, the task force also endorsed lipid screening in the same age group with the same B-grade as for statin use in the high-risk section.
Not enough evidence, though, is found by the task force for screening or prescribing statins to younger and older adults. In a separate draft for children, the proof for recommending for or against lipid screening was also deemed inadequate.
The American Academy of Pediatrics and the National Heart, Lung, and Blood Institute have recommended dyslipidemia screening for adolescents and specific high-risk groups, a move criticized for alleged lack of scientific evidence.
The AHA and ACC, while mum on cholesterol screening for kids, have shown support for screening 20 to 40 year old individuals to detect the genetic condition familiar hypercholesterolemia for early treatment.
The draft recommendations, which replace one from 2008, are open for public comment until January 25.
Photo: Ilmicrofono Oggiono | Flickr
