I’m sure you’ve seen the headlines, like I have. New statin guidelines issued by the American College of Cardiology and American Heart Association could double the number of patients taking statins.
So, what do the new statin guidelines say? The gist is that doctors should ignore a patient’s cholesterol numbers, and instead focus on four criteria that assess a patient’s overall cardiovascular risk.
The problem, though, is that these new guidelines are only 20-25% accurate. Here’s why…
Statin Guideline #1: Does the patient have coronary artery disease?
This guideline makes partial sense. As many of you know, I’ve long recommended statin drugs for men under the age of 75 with diagnosed coronary artery disease, a history of myocardial infarction, stents, angioplasty, or a coronary bypass. In fact, for men in this category statins are often under-prescribed.
But for women, this guideline doesn’t hold water. For women, the data fails to demonstrate that the benefits of statins outweigh the risks—including breast cancer and diabetes. So, in my opinion, the only women who should be on statins are those with advanced coronary artery disease who continue to deteriorate despite lifestyle interventions. I believe that less than 1% of women with coronary artery disease fall into this category.
Statin Guideline #2: Does the patient have type 1 or type 2 diabetes?
The use of statins in people with diabetes is highly controversial. First off, statins can actually contribute to type 2 diabetes. In fact, last year the FDA began requiring statin manufacturers to put a diabetes warning on their labels. So giving statins to people who already have diabetes doesn’t make sense.
Plus, the data demonstrates that for men with diabetes statin drug use can lead to calcification of the coronary arteries. There’s also documented evidence that cataracts are more common in those taking statin drugs. And since people with diabetes are already more prone to cataracts, the use of statins for this population can be harmful.
A far better intervention for people with type 2 diabetes, or pre-diabetes, is lifestyle changes—including diet therapy; weight reduction; avoidance of sugars; exercise; use of raw foods, particularly vegetables; and targeted nutritional supplements.
Statin Guideline #3: Is the patient’s LDL cholesterol greater than 190?
If you have true genetic familial hypercholesterolemia (which affects only one in 500 people) this guideline makes sense—since this condition can cause accelerated coronary artery disease even in those under 50. However, there are people with this genetic variant who have extremely high cholesterol levels and live well into their 80s and 90s.
It doesn't make sense to treat a high LDL number in the absence of this genetic situation. So this statement about treating LDL cholesterol over 190 has minimal validity.
Statin Guideline #4: Is the patient’s risk of having a heart attack greater than 7.5% over a 10 year period?
This guideline is highly confusing and complex—requiring physicians to calculate a patient’s risk based on age, race, blood pressure, smoking habits, and more. Unfortunately, this is likely to be poorly understood by physicians, resulting in the overzealous use of statins.
Plus, while some research, such as the West of Scotland Coronary Prevention Study, showed that high-risk men did have fewer coronary events while on statin drugs, the improvement wasn’t related to cholesterol. Instead, it was attributed to the blood thinning and anti-inflammatory effects of statins.
People at high risk for having a cardiac event can significantly—and safely—reduce their risk with lifestyle interventions that will cause no harm whatsoever. As I’ve stated many times, harmful statin side effects are grossly underestimated—so prescribing these drugs should not be taken lightly. For all of these reasons, I don’t think calculating “percentage of risk”—and using statins as the antidote—is the way to go.
So, what’s the bottom line? These new statin guidelines are only partially true and exaggerate the benefits of statin drugs. Statins are already overused in many population groups, with risks that don’t outweigh the rewards. What’s also important to remember is that the data does not strongly suggest statins improve longevity even though they reduce cardiovascular events.
My opinion of statins remains exactly the same. Statins should only be used in populations that get the most reward—which is middle-aged men with diagnosed coronary artery disease, those with familial hypercholesterolemia, and perhaps a minimal percentage of women. Plus, remember that there’s no data to suggest statins will improve longevity even in people with cardiovascular disease—so I would never recommend using statins as primary prevention.
Every patient is different, and prescribing a drug with an enormous side-effect profile based on an algorithm concept is, frankly, poor medicine. Doctors need to treat inpiduals with smart medicine—not guidelines, numbers, and unproven myths and dogma.
Now it's your turn: What do you think about these new statin guidelines?