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 In past recommendations, USPSTF focused on who should get testing
for cholesterol and triglycerides. Now, it says all adults ages 40
to 75 should get screened for high cholesterol and some of them
should receive statins to prevent future cardiovascular disease.
Speaking on behalf of the USPSTF, Dr. Doug Owens from Stanford
University in California told Reuters Health by email,
"Cardiovascular disease is serious - it can lead to heart attacks
and strokes, and is responsible for one in every three adult deaths
in the U.S.”
“People with no signs or symptoms and no past history of
cardiovascular disease can still be at risk, and a medication called
statins can help reduce that risk,” he said. “The Task Force
recommends that people who have a high risk of having a heart attack
or stroke over the next 10 years, as calculated by their doctor, and
who have a risk factor including high cholesterol, high blood
pressure, diabetes, or are a smoker, should consider taking a statin.
In addition, people with a lower risk may also benefit from taking a
daily statin.”
“It’s important that those who have concerns about their risk of
developing cardiovascular disease talk to their primary care doctor
to determine whether taking statins for prevention would be
beneficial for them,” Owens said.
He added, “Regardless of your risk for heart disease, everyone can
lower the chance that they will have a heart attack or stroke by not
smoking, eating a healthy diet, engaging in physical activity, and
limiting alcohol use. Managing high blood pressure and high
cholesterol and taking aspirin when indicated can also help.”
The new USPSTF recommendations appear in the Journal of the American
Medical Association, along with a review of the evidence supporting
them and several editorials expressing contrasting views about how
best to use statins in this setting.
Dr. Roger Chou from Oregon Health and Science University in
Portland, who coauthored the evidence review, told Reuters Health by
email, "Statins reduce the risk of first heart attack, stroke, or
death in persons with cardiovascular risk factors such as
hypertension, diabetes, smoking, and high cholesterol.”
He noted that people are often concerned with side effects of
statins, which can include muscle pain, liver problems, memory
issues, or diabetes. But the evidence review found no increase in
risk for these problems in people taking statins, compared to the
risks in people taking dummy pills.
“Further,” he said, “most side effects if they do occur will resolve
when the statin is stopped - but results of heart attacks and
strokes can be permanent or fatal.”
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Dr. Rita F. Redberg from the University of California, San
Francisco, who coauthored one of the editorials, questioned the
strength of the evidence, particularly with regard to the balance
between benefits and risks of statin treatment. She told Reuters
Health by email, "Be sure you understand your own chance of benefit,
as most people taking statins will never see a benefit from them.”
“Even the most optimistic calculations about statins say that of 100
people who take statins for five years, two will avoid a heart
attack and 98 will have no benefit,” she explained. “Yet,
approximately five to 20 of those 100 people will experience adverse
effects, including muscle aches, memory loss or brain fog, diabetes,
fatigue, and/or weakness.”
“The best way to stay healthy is not by taking a statin, but by
working on healthy lifestyle habits,” Redberg said. “Unfortunately,
data show that in the last decade people that take statins are more
likely to gain weight and be less active than people who do not take
a statin, perhaps due to a false reassurance from taking a statin.”
But Dr. Paul D. Thompson from Hartford Hospital in Connecticut, who
also wrote about statin-associated side effects, told Reuters Health
by email, "I have made a career on examining statin-associated
adverse effects and have umpteen papers on the topic, but am
convinced they do not affect the majority of patients, and I never
miss my statin despite my career interest!”
The bottom line: USPSTF says you should see your doctor to discuss
these recommendations and find out whether they apply to you.
SOURCE: http://bit.ly/2fQ5pG8 Journal of the American Medical
Association, online November 13, 2016.
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