Statins, drugs used to lower cholesterol, are among the most widely used medications in America. A study from Harvard health researchers concludes that they should be used even more widely, though.
In fact, the research team from the Harvard T.H. Chan School of Public Health says it would prove cost-effective to treat more than half of all adults aged 40 to 75 with statins. Doing so, the researchers argue, would prevent about 161,560 cardiovascular-related events.
The authors of the study concede that what they propose is controversial. In fact, they say the new cholesterol treatment guidelines, which recommend wider statin use, have sparked vigorous debate.
“Our goal for this study was to use the best available evidence to quantify the trade-offs in health benefits, risks, and costs of expanding statin treatment,” said Ankur Pandya, assistant professor of health decision science at Harvard Chan School and lead author of the study. “We found that the new guidelines represent good value for money spent on healthcare, and that more lenient treatment thresholds might be justifiable on cost-effectiveness grounds even accounting for side-effects such as diabetes and myalgia.”
The percentage of Americans taking statins has sharply increased. As of 2012, 26% of all adults over age 40 were taking them, according to the U.S. Centers for Disease Control and Prevention (CDC). With the increased use has come controversy.
In November 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) recommended that statins be prescribed for people with a 7.5% or greater risk of heart attack or stroke over a 10-year period, even if they had no cardiovascular issues. Previously, statins were prescribed only if the risk was 10-20% or higher.
Pros and cons
On one hand, proponents of expanding statin use say there is strong evidence that they are effective at reducing the risk of heart attack and stroke.
Critics responded that risks targeted by increasing statin use are overblown. There could be harm, they argue, in treating healthy people, and that more people would be at increased risk for negative side effects, such as memory loss, type 2 diabetes, and muscle damage.
There has been plenty of medical advice urging caution when it comes to prescribing statins. Doctors at the Mayo Clinic have long advised that the decision to go on a statin will depend on a number of risk factors that each particular patient faces.
High cholesterol is certainly one risk factor. If your total cholesterol level is 240 milligrams per deciliter (mg/dL) or higher, or your low-density lipoprotein cholesterol -- LDL, or "bad" cholesterol -- level is 130 mg/dL (3.37 mmol/L) or higher, your doctor may write a statin prescription.
But if high cholesterol is the only risk factor you have, the Mayo Clinic staff says you may not need a statin.
Another recent report, which was authored by cardiologists at Johns Hopkins, surveys a wide area of research and focuses on the benefits and potential downsides of long-term statin use. The researchers say patients should be made aware of the risks, not just the potential benefit.
"Given that heart disease tops mortality charts as the number one-killer of Americans, 'to statin or not to statin' is one of the most important questions faced by patients and physicians alike," said lead author Seth Martin, an assistant professor of cardiology at the Johns Hopkins University School of Medicine.