New Push to Place 1/3 of Americans on Statins Receives Backlash

Should 1/3 of adults be on cholesterol meds?

The American Heart Association and the American College of Cardiology recently issued new cholesterol guidelines that are estimated to double the number of American adults on statins (cholesterol lowering medications) from about 15% to 30%.

New Cholesterol guidelines would place 1/3 of adults on statins

Dr. Neil Stone, who headed the cholesterol guideline panel, explained to reporters, "We're going to give statins to those who are the most likely to benefit." The guidelines increase the emphasis on factors like age, gender, race, and smoking rather than cholesterol levels.

Trying to be more selective about the use of cholesterol medication sounds like a good idea, especially with increasing warnings about newly recognized risks over the past couple years. But when the plan results in doubling the number of American adults on cholesterol lowering medication (and those adults may not even have high cholesterol)...it seems like something went wrong.

We're not the only ones wondering about the new guidelines. The AHA and ACC have taken considerable heat from doctors and researchers.

Rita F. Redberg, a cardiologist at the University of California, San Francisco Medical Center and the editor of JAMA Internal Medicine and John D. Abramson, a lecturer at Harvard Medical School and the author of “Overdosed America: The Broken Promise of American Medicine,” noted flaws with these guidelines in a New York Times article:

"[This would be good news for patients] if statins actually offered meaningful protection from our No. 1 killer, heart disease; if they helped people live longer or better; and if they had minimal adverse side effects. However, none of these are the case."

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"...for people who have less than a 20 percent risk of getting heart disease in the next 10 years, statins not only fail to reduce the risk of death, but also fail even to reduce the risk of serious illness — as shown in a recent BMJ article co-written by one of us. That article shows that, based on the same data the new guidelines rely on, 140 people in this risk group would need to be treated with statins in order to prevent a single heart attack or stroke, without any overall reduction in death or serious illness."

"At the same time, 18 percent or more of this group would experience side effects, including muscle pain or weakness, decreased cognitive function, increased risk of diabetes (especially for women), cataracts or sexual dysfunction."

"Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease. According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day."

MedPage Today reported, "The issue took on increased intensity when word reached AHA and ACC leaders that Paul Ridker, MD, MPH, and Nancy Cook, ScD, of Brigham and Women's Hospital in Boston, had data showing that the new risk calculator greatly overestimates the risk of myocardial infarction and stroke by 75% to 150%, potentially resulting in the initiation of statin therapy in patients who don't need it."

Former AHA president Gordon Tomaselli, MD, of Johns Hopkins, said "the guidelines aren't perfect -- the risk assessment tool does, he said, have some 'holes because it probably is not a good tool for estimating risk in white women -- that's not new and there are other problems, but it is an improvement.'"

The New York Times later reported that past president of the American College of Cardiology and chief of cardiovascular medicine at the Cleveland Clinic, Dr. Steven Nissen, recommended implementation of the new guidelines be stopped: “It’s stunning. We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

There have been additional questions about the members of the guideline panel with ties to pharmaceutical companies.

Until these guideline problems are worked out, we recommend everyone take the steps that are confirmed to benefit their health - eat better, exercise, reduce stress, and enjoy a good night's sleep. These are powerful steps that we see help patients drop cholesterol and improve their health quickly; and cause good side effects like more energy and fewer aches and pains.