(RxWiki News) Heads or tails? Chocolate or vanilla? Life is full of decisions — even for doctors. A good discussion allows patients to share in the decision-making process for their health care.
Guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA) recommend a doctor-patient risk discussion to help with the decision on whether to start taking statins. This talk should inform patients of the risks and benefits of statin therapy. A recent paper makes some suggestions about how to structure this discussion.
Statins (such as Lipitor and Crestor) are the most common cholesterol-reducing medications in the United States. However, the decision to begin statin therapy is not always clear-cut.
“Given that heart disease tops mortality charts as the number one-killer of Americans, ‘to statin or not to statin’ is one of the most important questions faced by patients and physicians alike,” said lead author Seth S. Martin, MD, of Johns Hopkins University School of Medicine and Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, MD, in a press release. “Our report offers concrete tips for clinicians on how to conduct this vital discussion and to reduce patient uncertainty and frustration in making this complicated decision.”
Atherosclerotic heart disease is caused by narrowing and hardening of the blood vessels due to fatty plaque buildup. Reduced blood flow can prevent oxygen from getting to the heart and the brain. Without oxygen, these organs can fail.
The ACC/AHA guidelines say doctors should use a complex equation to determine a patient's risk of heart disease. This calculation takes into account cholesterol levels and other aspects of the patient's health. The final number gives the doctor a risk number for that patient. This number is used to determine whether statin therapy should be recommended.
Statins can reduce cholesterol levels and prevent the buildup of plaque. However, the use of statins can lead to muscle damage and diabetes. In patients with a high risk of heart disease, these risks are often minimal compared to those of heart disease.
Robert Phipps, RPh, owner of Fowlerville Pharmacy in Fowlerville, MI, told dailyRx News that patients should always ask their doctors why they're taking a statin, what their target cholesterol levels are, what to do if they experience side effects and what else they can do to lower their cholesterol.
"In my opinion, people always work better with a goal in mind," Phipps said. "In any part of life not just statin therapy. Weight, smoking, exercise, stress, eating habits, sleep, family history, alcohol, other drugs, the list goes on and on to help determine the risk of [heart disease]."
Patients with less heart disease risk fall within a gray area. The benefits and risks tied to statins should be carefully considered, Dr. Martin and team said.
Dr. Martin and team offered tips for structuring a doctor-patient risk discussion:
- Discuss the ACC/AHA app for computers and smartphones to help calculate risk.
- Discuss the patient's 10-year risk.
- Discuss lifestyle and medication options to reduce risk.
- Discuss risks of different types of statins.
- Discuss patient questions, values and preferences.
The goal of these steps is shared decision-making.
These guidelines were published online March 30 in the Journal of the American College of Cardiology.
Dr. Martin received funding from a Pollin Cardiovascular Prevention Fellowship, a Marie-Josée and Henry R. Kravis endowed fellowship and a National Institutes of Health training grant. Dr. Michael J. Blaha served on an advisory board for Pfizer. Dr. Ty J. Gluckman served as an expert witness for Takeda Pharmaceuticals. Dr. Roger S. Blumenthal received funds from the Kenneth Jay Pollin Professorship in Cardiology.