Cholesterol-lowering statins more widely recommended in U.S.

Cholesterol-lowering statins drug could be prescribed to more American adults under new guidelines, raising questions about overprescribing, a Canadian expert says.

Shifting statins to those who are the most likely to benefit

Cholesterol-lowering statins drug could be prescribed to more American adults under new guidelines, raising questions about overprescribing, a Canadian expert says. 

The American Heart Association and American College of Cardiology are shifting their focus from lowering "bad" or LDL cholesterol levels to heart and stroke risk. 

"We're going to give statins to those who are the most likely to benefit," said Dr. Neil Stone of Northwestern University in Chicago, who headed the cholesterol guideline panel. 

Statins are among the most widely prescribed drugs in Canada and the U.S. Amgen Canada Inc. says about 70 per cent of patients were on a statin at the start of the extension studies into its new generation cholesterol-lower medicine evolocumab. (Paul J. Richards/AFP/Getty)

Statins such as atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor) are among the widely used prescription drugs to lower cholesterol. More than 38 million prescriptions for statins were filled at Canadian pharmacies in 2012, according to IMS Brogan, which researches health care services.

The guidelines cover four topics:

  • Managing blood cholesterol. 
  • Managing overweight and obese patients. 
  • Assessing cardiovascular risk in adults. 
  • Preventing heart disease through healthy lifestyle. 

Under the new guidelines, one-third of all adults in the U.S. would be told to consider taking statins, compared with the current guideline that suggests the medication for about 15 per cent of adults. 

Dr. Lee Green is a family physician and chair of family medicine at the University of Alberta in Edmonton where he has studied statin prescribing. Green welcomes how the new U.S. guidelines' focus is turning away from chasing LDL but also worries about the potential to cast the statin use net too widely. 

Serious and milder side-effects

Previously, statins tended to be prescribed for those without a history of heart disease, stroke and with few risk factors who, according to critics of the drugs, likely wouldn't benefit from them but face potential side-effects. 

"It gets the right people the treatment," Green said of the new U.S. guidelines from a meeting in Ottawa. 

Family physicians see patients with milder side-effects like tiredness and muscle weakness that Green said may be underestimated in the published literature. 

The previous U.S. guidelines also missed some at high-risk, such as those over the age of 40 with Type 2 diabetes and cholesterol levels that are OK, Green said. 

Statins work to lower cholesterol, and also have anti-inflammatory and other effects that can reduce the risk of heart attack and stroke, he added. 

Last month, Dr. Jim Wright of the Therapeutics Initiative in Vancouver and his co-authors published an analysis in the British Medical Journal on statin use in low-risk people. 

Wright's team concluded 140 low-risk people would have to take statins for five years to prevent a single serious cardiovascular event such as a heart attack.

Wright is concerned about adverse events associated with use of statins in people who haven't had a heart attack, such as kidney damage and lesser known ones such as cataracts.

"If you're high risk because you smoke and you don't exercise should you then take a statin? It just doesn't seem rational," Wright said.

In contrast, regular physical activity and eating right helps with not only preventing heart attacks and stroke but also several kinds of cancer and liver disease, Green said. "Plus, it just plain makes people feel better."

Experts caution that people should not stop taking any heart drug without first checking with their doctor. 

With files from CBC's Renée Pellerin and The Associated Press