Cardiovascular disease (CVD) remains the leading cause of death in the United States. And one of the most effective preventive measures to lower the risk of a CVD event are statins — a class of cholesterol-lowering medications.
It’s well established that statins save lives, but a recent study finds that even after two years, half of all people prescribed statins don’t achieve healthy cholesterol levels.
Now researchers are exploring the viability of creating individually tailored treatments to help people better meet their cholesterol targets.
Elevated cholesterol is one of the most widely acknowledged contributors to CVD. In the United States, roughly one-third of adults have high levels of LDL, the most harmful type.
Statin drugs lower cholesterol by blocking a substance needed to make it. They can even help your body reabsorb built-up cholesterol on artery walls, preventing blockages and reducing CVD risk.
Dr. Nieca Goldberg, cardiologist and medical director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center told Healthline, “Statins are very effective at lowering LDL levels and lowering risk of cardiovascular disease.”
She added, “What people don’t realize is that only about 15 percent of high LDL is due to poor diet or lack of exercise. Much of it is genetically determined, so statins can be the best way to reduce levels.”
Both U.S. and U.K. guidelines to prevent deaths from cardiovascular disease establish treatment targets. The UK National Institute for Health and Care Excellence (NICE) specifies a 40 percent (or more) reduction in LDL.
U.K.-based researchers investigated just how well patients responded to statin treatment, according to the NICE recommendation, and how this affected their cardiovascular disease risk.
The researchers included 165,411 patients who hadn’t been treated for CVD before beginning statins.
They found that roughly half hadn’t responded well enough after two years on statins. There was also a higher rate of heart disease in those who failed to reach target LDL levels.
Dr. Ralph Akyea, a study author and research associate at the University of Nottingham, told Healthline, “We found that for every millimole fall in LDL cholesterol there was a 6 percent lower risk of CVD in those who failed to reach the 40 percent target, compared to a 13 percent drop in risk of CVD for those who attained the target.”
“Most surprising is the magnitude of the individuals prescribed statins for primary prevention of CVD not achieving the recommended reduction. These individuals are not getting the optimal benefits of being on statins for preventing heart disease and stroke,” said Akyea.
He continued, “This reinforces the health benefits of statins and also the benefits of reaching the target.”
The findings indicate that both genetics and stopping medication may explain these results.
Goldberg said, “Adherence in general is a problem; studies show that six months into treatment only half of patients will take a particular medicine. But with statins, people are often frightened by negative media attention regarding them.”
More individualized care may be the solution.
She thinks, “This can be remedied by doctors. If the reasons why statins are needed and how effective they are to reduce cholesterol is clearly explained, there’s a better chance that patients will stick with it.”
Dr. Victoria Shin, a cardiologist at Torrance Memorial Medical Center told Healthline, “All medicine should be personalized. Each patient comes with a special set of concurrent problems, sensitivities, and risk factors that can be determined by genetics, environment as well as lifestyle habits. It’s not ‘one size fits all’.”
A recent patient survey of almost 6,000 people found that nearly 20 percent of them weren’t receiving statin treatment, despite being eligible for it according to American College of Cardiology (ACC) and American Heart Association (AHA) guidelines.
Of those patients, 60 percent said they weren’t offered the drug, and others said concern about side effects was why they refused or discontinued use.
“Updating doctors on current guidelines could improve this, but another issue is how short doctor’s visits are in primary care — perhaps there’s not enough time. I think we have to do a better job in engaging physicians to have this discussion with patients,” said Goldberg.
Shin agreed: “It has always amazed me that patients are more apt to believe online blogs about the statin dangers and ignore scientific literature on the benefits. Physicians need to take time to educate our patients and discuss how this affects this particular patient.
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The majority of people tolerate statins very well, but there can be side effects.
Goldberg said a common one is muscle aches, and it’s important to tell your doctor if you experience this. “We do a blood test called the CPK that measures muscle breakdown. If it indicates a problem, we may recommend statins be stopped for a week or two, or reduce the dose. Often we can find a good balance just by adjusting the dose.”
“It can also raise enzymes on a liver function test, which we monitor by blood test. Additionally, all statins have the potential to cause some degree of mental fuzziness,” said Goldberg.
But Goldberg emphasized, “The benefits absolutely outweigh the risks.”
We can also take actions to keep our cholesterol numbers in a healthy range.
Goldberg said exercise can help. “Particularly aerobic exercise; walking, running, swimming, pick an exercise you like and do it.”
Regarding diet, “It’s about reducing saturated fat, the fat in meat and dairy products. You can use one percent dairy products instead, and while not eliminating meat — you should reduce the amount to small portions. The Mediterranean diet is what I recommend to my patients because it has healthy fats.”
Statins save lives, but a study found that half of people using statins don’t reach healthy cholesterol levels after two years of treatment. The problem is people not taking statins as prescribed and doctors not doing enough to educate their patients about the drug.
Individualized care that involves more time spent with patients and educating them about statin benefits can help. Healthcare providers should also stay up to date with prescribing guidelines.
While lifestyle and diet changes can reduce levels — statins are still the most effective way to reduce unhealthy LDL cholesterol levels.