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 People ages 40 to 75 with at least one risk factor for
cardiovascular disease and a 10 percent or greater risk of heart
attack or stroke over the next decade should take statin drugs, the
U.S. Preventive Services Task Force recommends.
Doctors may also consider prescribing the drugs for people in this
age group with a 7.5 percent to 10 percent risk of heart attack or
stroke based on the American Heart Association and American College
of Cardiology risk calculator (http://www.cvriskcalculator.com).
"In addition to a healthy lifestyle, statins are useful for people
at an elevated risk for cardiovascular disease," said Dr. Douglas
Owens, of Stanford University in California and a member of the
USPSTF.
Risk factors for cardiovascular disease include high total
cholesterol or triglycerides - known as dyslipidemia, high blood
pressure, diabetes and smoking. Ten-year risk of heart attack and
stroke is calculated based on these and additional factors like sex
and ancestry.
Heart disease, stroke and other cardiovascular diseases killed
almost 787,000 people in the U.S in 2011, according to the American
Heart Association.
Cholesterol, a type of fat in the blood, can build up in arteries
and increase the risk of heart attacks, strokes and other
cardiovascular problems. Statins lower cholesterol by blocking its
production in the liver.
This is the first time the USPSTF is making a recommendation on the
use of statins. It's based on analysis of existing data from 18
randomized controlled trials comparing statin use among people
without previous heart attacks and strokes to people taking dummy
pills or nothing at all.
Compared to those who are not on treatment, statin use was tied to a
17 percent reduced risk of death from any cause, and a 36 percent
reduced risk of death from cardiovascular disease.
People taking statins were also 28 percent less likely to have
strokes, 37 percent less likely to have heart attacks and 31 percent
less likely to have other cardiovascular problems.
The benefits of statins were consistent in people with different
risk factors, the panel found. And serious side effects like muscle
or liver problems and diabetes were not significantly increased
according to the analysis.
"We feel the benefits outweigh any potential harms," Owens told
Reuters Health.
Owen also said, however, that people who have the highest
cardiovascular risk will benefit the most from statins.
The new recommendation isn't surprising and is consistent with 2013
recommendations from the American Heart Association and American
College of Cardiology, according to Dr. Sekar Kathiresan, who wasn't
involved with the new recommendation but is director of preventive
cardiology at Massachusetts General Hospital in Boston.
Those organizations recommended statins for people ages 40 to 75
with diabetes or a 7.5 percent or greater risk of heart attack or
stroke over the next decade, people with a previous heart attack or
stroke and young people with very high LDL ("bad") cholesterol.
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Currently, 36 million Americans take statins, according to the
USPSTF.
Cholesterol and Triglycerides Among Children
In another recommendation published online on Monday, the USPSTF
proposed an update to its advice on testing children and teens for
dyslipidemia, sometimes known as familial high cholesterol because
it is usually inherited.
As it had in 2007, the panel said there is still not enough evidence
to recommend for or against screening people younger than age 20 for
the condition, which affects one in every 200 to 500 people across
North America and Europe.
The statement is in line with the advice of the UK National
Screening Committee and the American Academy of Family Physicians.
Owens said this is an area for future research, because it's an
important topic.
"We’d say if you have concerns or any concern of elevated risk, it
would be time to have a conversation with a child’s clinician," he
said.
The panel also points out that the American Academy or Pediatrics (AAP)
and the National Heart, Lung, and Blood Institute endorse universal
screening for all children before ages nine and 11, and again
between puberty and adulthood. Earlier testing is recommended for
children at an increased risk of the condition.
"I actually tend to err on the side of AAP here, because it’s quite
common and treatable," Kathiresan told Reuters Health.
"I think it’s appropriate for a national body to say we don’t have
definitive evidence," he said, but he added that the problem is that
finding the condition when a person is young is an incredible
opportunity to modify risks in those people.
He said it's likely a discussion for a parent to have with their
child's pediatrician.
Both recommendations are available for public comment on the
USPSTF's website until January 25, 2016.
SOURCE: http://bit.ly/1euI2Rl U.S. Preventive Services Task Fource,
online December 21, 2015.
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