New guidelines for statin users will increase prescription drug users

Recently released prescription guidelines increase the number of adults likely to benefit from cholesterol-lowering drugs called statins from 15.5% to 31%.

Currently, doctors prescribe statins, which inhibit HMG-CoA reductase along the hepatic cholesterol synthesis pathway, largely to prevent heart attacks. They base such prescriptions on initial cholesterol levels, lowering or raising dosages based on target LDL levels for each patient. Over the years that this class of drugs has been in prodcution, Crestor, Lipitor and Zocor have become common household names, and $37 billion is spent on cholesterol-lowering meds worldwide.

In an attempt to better distribute these medications, the American College of Cardiology and the American Heart Association collaborated with the National Heart, Lung and Blood Institute to generate new criteria for those likely to benefit from taking statins: people with preexisting heart disease, diabetics aged 40 to 75, people aged 40 to 75 with at lease a 7.5% change of developing cardiovascular disease in 10 years and people with LDL levels of 190mg/dL or higher.

In lieu of proposing these specific groups, the authors advised doctors to look at a patient’s overall risk of cardiovascular disease rather than just cholesterol levels when determining whether or not to prescribe statins.  Furthermore, the guidelines call for doctors to work closely with patients to improve diet and exercise.  This demonstrates the author’s recognition of the link between obesity and cardiovascular disease, as being overweight increases the risk of heart attack, stroke, diabetes and early death.

According to Dr. Donna Ryan, a professor emeritus at Louisiana State University’s Pennington Biomedical Research Center and a co-author of these new guidelines, diet, physical activity and face-to-face behavioral counseling can lead to a 3 to 5% reduction in weight. Weight loss will lower blood pressure, improve blood cholesterol levels, and reduce the need for medication to manage the heart.

With all this superficial focus on a holistic, lifestyle-based form of medicine, why did the new criteria double the number of adults likely to benefit from statins?  The answer lies in the third high risk group: the report says that patients at risk for cardiovascular disease within the next ten years should change poor lifestyle habits and seek immediate drug therapy. Thus, although lifestyle changes appear as a viable form of preventative care, the dependence remains on statins. Furthermore, in suggesting drug therapy for those only likely to develop cardiovascular disease, the authors of these guidelines have slipped statins into preventative care regimens.