In a cohort of
individuals aged 66-75 years, 97 percent now qualify for a statin
Nearly all individuals in their late 60s and early 70s --
including 100 percent of men -- now qualify for and should consider starting a
statin medication to reduce their risk of cardiovascular disease, under the
recently released cholesterol guidelines from the American College of
Cardiology (ACC) and the American Heart Association (AHA).
That's according to a research letter published today in the
11/20/2014 (JAMA-IM) by Michael D. Miedema, MD, MPH, a research cardiologist
at Minneapolis Heart Institute Foundation and cardiologist at Minneapolis Heart
Institute® at Abbott Northwestern Hospital.
Released in November 2013, the ACC/AHA guidelines for the
treatment of blood cholesterol attempt to target individuals that are most
likely to benefit from cholesterol-lowering statin therapy.
"The guidelines are a significant change from prior
guidelines that relied heavily on levels of bad cholesterol to determine who to
treat," states Dr. Miedema. "Instead, the new guidelines recommend
focusing statin therapy on the individuals that are at the highest risk for
heart attack and stroke, even if their cholesterol levels are within normal
limits."
In addition to recommending statin therapy for individuals
with known cardiovascular disease, diabetes, or markedly elevated cholesterol
levels, the guidelines also recommend statin therapy for individuals without
these conditions, but with an elevated estimated risk of a heart attack or
stroke in the next 10 years based on a risk calculator. The calculator factors
in an individual's age, gender, race, and risk factors and recommends that
patients with an estimated 10-year risk above 7.5% consider statin therapy.
While Dr. Miedema believes the scientific evidence supports
this "risk-based" approach, one potential concern is that the risk
calculator relies too heavily on age to determine an individual's risk.
"Older individuals will likely cross the 7.5% threshold based on age
alone, even if they have normal cholesterol levels and no other cardiovascular
risk factors, and our study confirms this notion."
Miedema and his colleagues studied 6,088 black and white
adults between the ages of 66 and 90 in the Atherosclerosis Risk in Communities
(ARIC) Study, a longitudinal study of cardiovascular disease sponsored by the
National Heart, Lung, and Blood Institute that has been following participants
for about 25 years. The ARIC cohort was reassessed in 2013, and the study
analyzed the volume of statin-eligible participants based on the previous Adult
Treatment Panel (ATP) III cholesterol guidelines compared to the newer ACC/AHA
guidelines.
"Based on the ATP III guidelines, we found that just over
70% of the ARIC participants were eligible for statin therapy," Miedema
said. "In contrast, 97 percent were statin eligible by ACC/AHA criteria.
For men 66-75 years old, the qualification rate was 100 percent."
While half of the cohort was older than 75, the ACC/AHA
guidelines do not provide a recommendation for or against statin therapy for
people of that age group. However, researchers noted that more than half of
these older individuals in the study were taking a statin.
"We don't have great data on the efficacy of statin
medications in the elderly so the guidelines drew a cut-off for the
recommendations at age 75," Miedema said. "This is understandable,
but it kind of leaves clinicians in the dark as to what to do with healthy
elderly patients, who are often at high risk for heart attacks and
strokes."
"We clearly need more research looking at the best way to
determine who should and should not take a statin, as well as the risks and
benefits of statin therapy in elderly patients," Miedema said.
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