Cholesterol-lowering drugs such as Lipitor and Crestor are already the most commonly prescribed drugs in the country, taken by nearly one in four U.S. adults ages 45 to 64 and about half of those 65 and older. Now new guidelines from the American Heart Association and the American College of Cardiology could, by some estimates, nearly double that number. But Consumer Reports’ medical experts say you should wait until more is known about how the guidelines were developed and what they will mean in real life before assuming you need to start taking a statin. And they worry that lost in the hoopla over drugs is the growing recognition about how effective lifestyle changes can be in reducing your risk of heart attack and stroke.
The new guidelines try to simplify the advice on who needs to lower their cholesterol with drugs. Most notably, instead of setting levels of LDL (bad) cholesterol that people should try to reach—for example, below 130 milligrams per deciliter or 100 mg/dl—the guidelines identify four broad groups of people who, they say, are likely to benefit from statins. Those four groups include:
- People with a history of heart attack, stroke, or other forms of cardiovascular disease
- People ages 40 to 75 who have diabetes
- People with a very high LDL level (190 mg/dl or higher)
- People with an estimated risk of having a heart attack or stroke in the next 10 years that is 7.5 percent or higher, based on a new calculator developed by the American Heart Association and the American College of Cardiology
“The new emphasis on risk rather than LDL targets does make sense,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “That is something we have recommended for years.” And statins are a good choice for the first three groups of people in the new guidelines. In them, the drugs clearly save lives.
See our advice on how to prevent and treat heart heart disease and our Best Buy Drugs recommendations for statins.
But he worries about the fourth group of people—those who have a 10-year cardiovascular risk of 7.5 percent or higher—for several reasons. First, some experts have questioned the accuracy of the new calculator developed by the AHA and ACC, saying that it overestimates risk. And others think that, even if the calculator is accurate, the 7.5 percent cut-off may be too low. “We need to better understand how the calculator works, and if the new recommendations are overkill,” Lipman says.
In the meantime, though, Lipman says people should be paying much more attention to another area of the new guidelines, the growing recognition of the power of lifestyle changes. “There are a lot of things you can do to protect your heart: get yourself moving, lose weight, get your blood presssure under control, eat right, stop smoking, and consider a low-dose aspirin, for example,” he says. “Take those steps, and you can lower your risk of heart attack and stroke dramatically, and may not need a statin at all.”
—Doug Podolsky
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