Many Not Getting Statins When They May Benefit

Statin use dictated by high cholesterol levels rather than overall cardiovascular risk

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) People take statin medications to fight high cholesterol. While these medications also may help those with high heart risks but not high cholesterol, statins are not always prescribed to those patients.

Statins, which can reduce the chances of having a heart attack or stroke, have usually been prescribed based on a patient’s cholesterol levels. In the fall of 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines recommending that statins be given according to an individual’s risk of heart attack or stroke rather than cholesterol targets.

A new study has found that millions of patients with coronary artery disease and/or diabetes who could benefit from statins are not receiving these medications.

"Talk to your doctor about statins to lower your cardiovascular risks."

Michael Edward Johansen, MD, assistant professor of clinical family medicine at 
The Ohio State University in Columbus, and his colleagues analyzed information on 16,712 people, ages 30 to 79, who participated in the 2010 Medical Expenditure Panel Survey. 

These researchers classified statin users as those filling at least two statin prescriptions a year.

Statins include atorvastatin (brand name Lipitor), fluvastatin (brand name Lescol), lovastatin (brand name Mevacor), pitavastatin (brand name Livalo), pravastatin (brand name Pravachol), rosuvastatin (brand name Crestor) and simvastatin (brand name Zocor).

Dr. Johansen and his team calculated that about 9 million people with diabetes over the age of 40 and 5.6 million people with coronary artery disease are not taking statins. They estimated that 52 percent of those over 40 with diabetes and 58 percent of individuals with coronary artery disease are on the medication.

The authors of this study noted previous research finding that patients with coronary artery disease who take statins may cut their overall death risk by about 16 percent and those over 40 with diabetes may lower cardiovascular disease outcomes by more than 30 percent.

“In this nationally representative sample, many people at high risk for cardiovascular events, including those with coronary artery disease, diabetes, or both, were not receiving statins despite evidence that these agents reduce adverse events,” the authors wrote. “This undertreatment appears to be related to placing too much emphasis on hyperlipidemia [high blood cholesterol] and not enough on cardiovascular risk.”

The scientists added that recently released guidelines from the American College of Cardiology and the American Heart Association offer an opportunity to improve statin use by focusing on cardiovascular risk instead of lipid levels.

While the AHA and ACC suggest statins for anyone with very high levels of LDL ("bad") cholesterol, which is generally considered to be levels higher than 190 mg/dL, they note that these medications may also lower the likelihood of heart attack, stroke and premature death among those with relatively normal cholesterol levels.

Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, Texas, told dailyRx News, “What many patients, and some physicians, don't realize is that statins reduce heart attack and stroke risk not only by lowering cholesterol, but also through other mechanisms that are not as well understood. Probably one of the most important of these is the effect statins have on decreasing inflammation within the lining of the arteries. This makes them less vulnerable to cholesterol buildup, while at the same time helping to stabilize the existing plaque so that it is less likely to cause a sudden blockage of the artery. This is why the drugs are recommended even for people with normal cholesterol levels.”

The new AHA/ACC guidelines recommend statins for those who have cardiovascular disease, including previous heart attack, stroke or angina (chest pain or discomfort in area of the heart muscle if it doesn’t get enough oxygen-rich blood); those with a greater than 7. 5 percent chance of having a heart attack or stroke in the next 10 years; and those between 40 and 75 years old who have diabetes.

This study was published in the May/June issue of the Annals of Family Medicine. Authors reported no conflicts of interest. 

Review Date: 
May 12, 2014
Last Updated:
May 13, 2014