Nav: Home

Statins overprescribed for primary prevention

December 06, 2018

Even healthy people who don't suffer from a cardiovascular disease are prescribed cholesterol-lowering drugs, known as statins, if they meet certain risk criteria. However, for years the use of statins for primary prevention has been hotly debated among experts. "Ultimately, this measure helps to prevent heart attacks or strokes in only a few cases. But all people who take statins are at risk of experiencing the side effects," says Milo Puhan, professor of epidemiology and public health at the University of Zurich.

No systematic studies for guidelines

When deciding whether to prescribe statins to a patient, doctors use a number of risk factors such as cholesterol level, BMI and smoking to determine the likelihood of a person suffering a heart attack or stroke in the next 10 years. If this figure reaches or exceeds 10%, many medical guidelines recommend the use of statins; however, some guidelines put this number at 7.5%, whereas a Swiss association of general practitioners only suggests doing so from 20%.

If these guidelines, most of which are drawn up by cardiology organizations, are to be believed, more than one third of all people between the age of 40 and 75 would have to take statins as a preventive measure - in other words, hundreds of millions of people around the world. According to Puhan, however, these guidelines were drawn up without properly taking into account the unwanted side effects, such as muscle pain, cataracts, liver defects or diabetes. "The thresholds set by experts aren't based on any systematic studies."

Weighing up benefits and harmful effects

Striking a good balance between the benefits and the harmful side effects is therefore one of the great challenges of developing improved guidelines for preventive statin use. This is why Prof. Milo Puhan and his team at the Epidemiology, Biostatistics and Prevention Institute of UZH have now for the first time carried out a comprehensive statistical modeling study.

The researchers systematically compiled all data from specialist literature that documents the benefits and side effects of the preventive use of statins. To include the view of patients in their model, they also performed a survey among healthy people about the significance of heart attacks, strokes and certain side effects.

Using this information, the scientists determined new thresholds for men and women across different age groups between 40 and 75. They also compared the benefits and unwanted side effects of four widely used statin preparations.

Recommendation given to too many people

"Our study shows that today statins are recommended far too often," says Puhan about the study's findings. According to his estimates, the newly set thresholds could cut the number of people who are given a recommendation to take statins by half.

The benefits of cholesterol-lowering drugs have been greatly exaggerated particularly when it comes to senior citizens: For the 70 to 75 age group, the study's model put the threshold at approx. 21% - in other words, the benefits of statins outweigh the harm from potential side effects of statins only if there's a 21% risk or higher that a person will suffer a heart attack or a stroke in the next 10 years. For men and women aged 40 to 45, the threshold is slightly lower, at 14% and 17% respectively. The researchers also noted that two of the four examined statin preparations, atorvastatin and rosuvastatin, had a significantly better balance of benefits and harms than the other two (simvastatin und pravastatin).

Considering the study's findings, Puhan recommends that all people concerned should discuss their individual risk for cardiovascular disease as well as possible side effects with their doctors before deciding whether to take statins as a preventive measure.
-end-


University of Zurich

Related Heart Attack Articles:

Where you live could determine risk of heart attack, stroke or dying of heart disease
People living in parts of Ontario with better access to preventive health care had lower rates of cardiac events compared to residents of regions with less access, found a new study published in CMAJ (Canadian Medical Association Journal).
Activated T-cells drive post-heart attack heart failure
Chronic inflammation after a heart attack can promote heart failure and death.
ICU care for COPD, heart failure and heart attack may not be better
Does a stay in the intensive care unit give patients a better chance of surviving a chronic obstructive pulmonary disease (COPD) or heart failure flare-up or even a heart attack, compared with care in another type of hospital unit?
Heart attack treatment might be in your face
Researchers at the University of Cincinnati have received $2.4 million in federal funding to pursue research on a novel cell therapy that would repair heart damage using modified cells taken from the patient's own facial muscle.
Tissue engineering advance reduces heart failure in model of heart attack
Researchers have grown heart tissue by seeding a mix of human cells onto a 1-micron-resolution scaffold made with a 3-D printer.
Study shows functional effects of human stem cell delivery to heart muscle after heart attack
Researchers delivered human stem cells seeded in biological sutures to the damaged heart muscles of rats following induced acute myocardial infarction and assessed the effects on cardiac function one week later.
Younger heart attack survivors may face premature heart disease death
For patients age 50 and younger, the risk of premature death after a heart attack has dropped significantly, but their risk is still almost twice as high when compared to the general population, largely due to heart disease and other smoking-related diseases The risk of heart attack can be greatly reduced by quitting smoking, exercising and following a healthy diet.
After the heart attack: Injectable gels could prevent future heart failure (video)
During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells in the heart.
Heart failure after first heart attack may increase cancer risk
People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared to first-time heart attack survivors without heart failure, according to a study today in the Journal of the American College of Cardiology.
1 in 4 patients develop heart failure within 4 years of first heart attack
One in four patients develop heart failure within four years of a first heart attack, according to a study in nearly 25,000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr.

Related Heart Attack Reading:

The Cardiac Recovery Handbook: The Complete Guide to Life After Heart Attack or Heart Surgery, Second Edition
by Paul Kligfield M.D. (Author), Michelle D. Seaton (Author), Frederic Flach MD KCHS (Afterword)

Beat the Heart Attack Gene: The Revolutionary Plan to Prevent Heart Disease, Stroke, and Diabetes
by Bradley Bale M.D. (Author), Amy Doneen ARNP (Author), Lisa Collier Cool (Contributor), Larry King (Contributor)

Too Young for a Heart Attack
by Stu Segal (Author), Stephen H. Segal (Consultant Editor), Dr. Ian J. Molk M.D. (Consultant Editor)

Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure
by Caldwell B. Esselstyn Jr. (Author)

Prevent a Second Heart Attack: 8 Foods, 8 Weeks to Reverse Heart Disease
by Janet Bond Brill Ph.D. R.D. (Author), Annabelle S. Volgman M.D. (Foreword)

The Cardiac Recovery Cookbook: Heart Healthy Recipes for Life After Heart Attack or Heart Surgery
by M. Laurel Cutlip LN RD (Author), Sari Greaves RDN (Author), Paul Kligfield M.D. (Foreword)

Heart 411: The Only Guide to Heart Health You'll Ever Need
by Marc Gillinov M.D. (Author), Steven Nissen M.D. (Author)

Heart Attack: Truth, Tragedy, Triumph
by William A. Cooper (Author)

The Easy Heart Healthy Cookbook for Slow Cookers: 130 Prep-and-Go Low-Sodium Recipes
by Nicole R. Morrissey MS RD BC-ADM (Author)

Fat and Cholesterol Don’t Cause Heart Attacks and Statins Are Not The Solution
by Columbus Publishing Ltd

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Circular
We're told if the economy is growing, and if we keep producing, that's a good thing. But at what cost? This hour, TED speakers explore circular systems that regenerate and re-use what we already have. Guests include economist Kate Raworth, environmental activist Tristram Stuart, landscape architect Kate Orff, entrepreneur David Katz, and graphic designer Jessi Arrington.
Now Playing: Science for the People

#504 The Art of Logic
How can mathematics help us have better arguments? This week we spend the hour with "The Art of Logic in an Illogical World" author, mathematician Eugenia Cheng, as she makes her case that the logic of mathematics can combine with emotional resonance to allow us to have better debates and arguments. Along the way we learn a lot about rigorous logic using arguments you're probably having every day, while also learning a lot about our own underlying beliefs and assumptions.