On Statins

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Statins (Lipitor, Crestor, etc.) have been proven to lower total cholesterol and low-density lipoprotein (LDL or “bad” cholesterol), which has been shown to prevent or delay the onset of heart disease. They also help to stabilize heart disease in someone who already has it. The problem for both clinicians and patients is determining when to start statin therapy because there are a number of guidelines available and they all differ in their recommendations.

The first step in deciding when to start statin treatment is to determine what the person’s risk of developing heart disease is. In addition the risk of someone who already has heart disease, having worsening disease needs to be assessed. Patients can be stratified into risk categories that range from very high to low, based on a number of factors. Among these factors are age, gender, total cholesterol, systolic blood pressure, smoking history, family history, abdominal obesity, diabetes, physical activity, and kidney disease. For example, a 40-year-old with a history of hypertension and smoking has the same risk of developing heart disease as a healthy, non-smoking 65-year-old.

Elevated lipid treatment guidelines are provided by a number of organizations and agencies including the VA/DoD (Dept. of Defense), American College of Cardiology (ACC)/American Heart Association (AHA), and the European Atherosclerosis Society/European Society of Cardiology. Let’s look at the ACC/AHA treatment recommendations. They recommend the following: High-dose statin for patients under 75 years of age with heart disease, high-dose treatment for adults aged 21 or older with LDL (“bad cholesterol”) over 190, moderate to high-dose treatment for persons aged 40-75 with diabetes and LDL greater than 70, and adults aged 40-75 with LDL over 70 without diabetes or heart disease but with a moderate to high-risk of developing heart disease, they also recommend a physician – patient discussion before starting treatment.

The ACC/AHA also recommends a fasting lipid blood test four to 12 weeks after initiation of treatment, and repeat testing every three to 12 months thereafter. The frequent testing is important for several reasons. First, to assess whether the treatment is effective at getting the patient to their lipid goals. Also to assess whether the patient is actually taking the medication (many people do not take meds as prescribed). And to assess whether the medication is causing any side effects (like muscle or liver issues).

So if you have not done so, get to your doctor to have your risk of developing heart disease assessed. If you are taking a statin, be sure to get regular blood testing to evaluate the efficacy of the treatment and its potential side effects. And if you smoke, please stop. Smoking is thought to be the number one risk factor for a host of negative health issues including heart disease.

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