Almost half of Americans ages 40 to 75 and nearly all men older than 60 qualify to consider cholesterol-lowering statin drugs under new heart disease prevention guidelines, an analysis concludes.
It’s the first independent look at the impact of the guidelines issued in November and shows how dramatically they shift more people toward treatment. Supporters say they reveal the true scope of heart risks in America. Critics have said the guidelines overreach by suggesting medications such as Zocor and Lipitor for such a broad swath of the population.
“We wanted to be really objective and just quantify what the guidelines do and not get into a discussion about whether they are correct,” said Michael Pencina, a Duke University biostatistician who led the analysis. It was published online Wednesday by The New England Journal of Medicine.
Under the new guidelines, 56 million Americans ages 40 to 75 are eligible to consider a statin; 43 million were under the old advice. Both numbers include 25 million people taking statins now.
“That is striking ... eye-opening,” Dr. Daniel Rader of the University of Pennsylvania said of the new estimate.
But because too few people use statins now, the advice “has the potential to do much more good than harm,” said Rader, a cardiologist who had no role in writing the guidelines.
Nearly half a million additional heart attacks and strokes could be prevented over 10 years if statin use was expanded as the guidelines recommend, the study estimates.
The guidelines, developed by the American Heart Association and American College of Cardiology at the request of the federal government, were a big change. They give a new formula for estimating risk that includes blood pressure, smoking status and many factors besides the level of LDL or “bad” cholesterol.
For the first time, the guidelines are personalized for men and women and blacks and whites, and they take aim at strokes not just heart attacks. Partly because of that, they set a lower threshold for using statins to reduce risk.
The guidelines say statins do the most good for people who already have heart disease, those with very high LDL of 190 or more and people older than 40 with Type 2 diabetes.
They also recommend considering statins for anyone 40 to 75 who has an estimated 10-year risk of heart disease of 7.5 percent or higher, based on the new formula. (This means that for every 100 people with a similar risk profile, seven or eight would have a heart attack or stroke within 10 years.)
Under this more nuanced approach, many people who previously would not have qualified for a statin based on LDL alone now would, while others with a somewhat high LDL but no other heart risk factors would not.
The Duke researchers gauged the impact of these changes by using cholesterol, weight and other measurements from health surveys by the Centers for Disease Control and Prevention. They looked at how nearly 4,000 people in these surveys would have been classified under the new and old guidelines, and projected the results to the whole country.
The biggest effect was on people 60 and older, researchers found. Under the new guidelines, 87 percent of such men not already taking a statin are eligible to consider one; only 30 percent were under the old guidelines. For women, the numbers are 54 percent and 21 percent, respectively.
Dr. Paul Ridker and Nancy Cook of Brigham and Women’s Hospital in Boston have criticized the risk formula in the guidelines. Ridker declined to be interviewed, but in a statement, he and Cook noted that most people newly suggested for statins do not have high cholesterol but smoke or have high blood pressure. Those problems and lifestyle changes should be addressed before trying medications – which the guidelines recommend – they write.
Dr. Neil Stone, the Northwestern University doctor who helped lead the guidelines work, stressed that the guidelines just say who should consider a statin, and they recommend people discuss that carefully with a doctor.
“We think we’re focusing the attention for statins on those who would benefit the most,” Stone said.
Dr. Harlan Krumholz, a Yale University cardiologist who has long advocated this approach, agreed.
“The guidelines provide a recommendation, not a mandate” for statin use, he said.
Pencina, the leader of the Duke study, said his own situation motivated him to look at the guidelines more closely. His LDL was nearing a threshold to consider a statin under the old guidelines, but under the new formula for gauging risk, “I’m fine,” he said.
Conspiracy theories about health care abound
Nearly half of American adults believe the federal government, corporations or both are involved in at least one conspiracy to cover up health information, a new survey found.
Conspiracy theories on everything from cancer cures to cellphones to vaccines are well-known and accepted by sizable segments of the population, according to a research letter published this week in JAMA Internal Medicine.
The findings reflect “a very low level of trust” in government and business, especially in pharmaceutical companies, said study co-author Eric Oliver, a professor of political science at the University of Chicago. They also reflect a human tendency to explain the unknown as the work of “malevolent forces,” he said.
The online survey of 1,351 adults found:
37 percent agree the Food and Drug Administration is keeping “natural cures for cancer and other diseases” away from the public because of “pressure from drug companies.”
20 percent believe health officials are hiding evidence that cellphones cause cancer.
20 percent believe doctors and health officials push child vaccines even though they “know these vaccines cause autism and other psychological disorders.” Smaller numbers endorse theories involving fluoride, genetically modified foods and the deliberate infection of African Americans with HIV.
49 percent believe at least one of the theories, and 18 percent believe at least three.
“There are a lot of people out there that harbor these beliefs,” Oliver says, even in the face of scientific evidence to the contrary – such as the many studies showing no link between autism and vaccines.
The beliefs also go along with certain health behaviors, the survey found. Those who believe at least three health conspiracy theories are less likely to use sunscreen, get flu shots or get check-ups and are more likely to use herbal remedies and eat organic foods.
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