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If you are middle-aged and have even one risk factor for cardiovascular disease, you might need statins to prevent a future stroke or heart attack, according to new recommendations from the government-backed U.S. Preventive Services Task Force (USPSTF).
In past recommendations, USPSTF focused on who should get testing for cholesterol and triglycerides. Now, it says all adults ages 40 to 75 should get screened for high cholesterol and some of them should receive statins to prevent future cardiovascular disease.
"Cardiovascular disease is serious - it can lead to heart attacks and strokes, and is responsible for one in every three adult deaths in the U.S.," Dr. Doug Owens of Stanford University in California, speaking on behalf of the USPSTF, told Reuters Health by email,
"People with no signs or symptoms and no past history of cardiovascular disease can still be at risk, and a medication called statins can help reduce that risk," he said.
"The Task Force recommends that people who have a high risk of having a heart attack or stroke over the next 10 years, as calculated by their doctor, and who have a risk factor including high cholesterol, high blood pressure, diabetes, or are a smoker, should consider taking a statin. In addition, people with a lower risk may also benefit from taking a daily statin."
"It's important that those who have concerns about their risk of developing cardiovascular disease talk to their primary care doctor to determine whether taking statins for prevention would be beneficial for them," Owens said.
"Regardless of your risk for heart disease, everyone can lower the chance that they will have a heart attack or stroke by not smoking, eating a healthy diet, engaging in physical activity, and limiting alcohol use. Managing high blood pressure and high cholesterol and taking aspirin when indicated can also help."
The new USPSTF recommendations appear in the Journal of the American Medical Association, along with a review of the evidence supporting them and several editorials expressing contrasting views about how best to use statins in this setting.
"Regardless of your risk for heart disease, everyone can lower the chance that they will have a heart attack or stroke by not smoking, eating a healthy diet, engaging in physical activity, and limiting alcohol use."
Dr. Roger Chou from Oregon Health and Science University in Portland, who coauthored the evidence review, told Reuters Health by email, "Statins reduce the risk of first heart attack, stroke, or death in persons with cardiovascular risk factors such as hypertension, diabetes, smoking, and high cholesterol."
He noted that people are often concerned with side effects of statins, which can include muscle pain, liver problems, memory issues, or diabetes. But the evidence review found no increase in risk for these problems in people taking statins, compared to the risks in people taking dummy pills.
"Further, most side effects if they do occur will resolve when the statin is stopped - but results of heart attacks and strokes can be permanent or fatal," Chou said.
Dr. Rita Redberg from the University of California, San Francisco, who helped write a commentary in the Journal of the American Medical Association, questioned the strength of the evidence, particularly with regard to the balance between benefits and risks of statin treatment. She told Reuters Health by email, "Be sure you understand your own chance of benefit, as most people taking statins will never see a benefit from them."
"Even the most optimistic calculations about statins say that of 100 people who take statins for five years, two will avoid a heart attack and 98 will have no benefit," she said. "Yet, approximately five to 20 of those 100 people will experience adverse effects, including muscle aches, memory loss or brain fog, diabetes, fatigue, and/or weakness," she added.
"The best way to stay healthy is not by taking a statin, but by working on healthy lifestyle habits," Redberg said. "Unfortunately, data show that in the last decade people that take statins are more likely to gain weight and be less active than people who do not take a statin, perhaps due to a false reassurance from taking a statin."
But Dr. Paul Thompson from Hartford Hospital in Connecticut, who also wrote about statin-associated side effects, told Reuters Health by email, "I have made a career on examining statin-associated adverse effects and have umpteen papers on the topic, but am convinced they do not affect the majority of patients, and I never miss my statin despite my career interest!"