A group of Minneapolis cardiologists is recommending that more people take statin medications after a review of more than 1,000 heart attack victims found a high number who weren’t taking the cholesterol-lowering drugs.
Among patients in the study group who suffered their first heart attacks, only one in five were taking statins — meaning that many were defying the latest guidelines about who should be taking the medications, according to the cardiologists’ research, which was published in the latest edition of the Journal of the American Heart Association.
One surprise was the number of heart attacks among Minnesota adults who had relatively “average” cholesterol levels, said Dr. Michael Miedema, a lead author of the study and a cardiologist at the Minneapolis Heart Institute. Among those who suffered their first heart attacks, the median LDL cholesterol level was 110, which is only slightly above the ideal range.
“Even if you have a normal cholesterol level, that doesn’t mean you won’t benefit from the medication,” he said.
“Lower is better. It’s very much a linear relationship. As your cholesterol goes up your risk goes up, but as your cholesterol goes down your risk goes down. There’s no magic threshold.”
Miedema said he hopes the results will counter “statin gossip” that has scared some patients away from taking the drug.
Medical debate over statins continues, though. Late last year, a study in the journal Lancet indicated that statins prevented 80,000 major cardiovascular events every year in the United Kingdom and concluded that twice as many adults should be taking them. A small group of doctors criticized the conclusions, saying they exaggerated the actual study data, and asserted that the “downplaying of side effects has likely led to the overmedication of millions of people.”
Miedema said some studies highlighting side effects focused on older statins and said newer versions have shown in studies to have no more risk of side effects than sugar pills. One known risk, however, is a slight elevation in blood sugar that can push some patients into the diabetes range, he noted.
The Minneapolis study favors screening guidelines developed by the American Heart Association and the American College of Cardiology, which recommend statins for people with LDL levels above 190, diabetes, or prior heart disease. It also recommends statins for adults ages 40 to 75 with cholesterol levels above 110 who are assessed to have a 7.5 percent chance or greater of a cardiac event in the next decade.
That contrasts with an earlier guideline called the Adult Treatment Panel, which recommends statins for people with LDL levels at 130, 160 or 190 depending on other risks.
Among heart attack victims in the Minneapolis study who weren’t taking statins, only 38.7 percent would have come under the recommendations of the ATP guidelines. But 79 percent would have been encouraged to take statins under the AHA/ACC guidelines.
“I knew the [AHA] guidelines would be better,” Miedema said. “I didn’t know they would be this much better.”
The study used the Minneapolis institute’s database of heart attack patients, one of the largest in the nation, and was funded by the institute’s foundation. None of the authors reported financial ties to statin drug manufacturers.
Another influential source of medical guidance, the U.S. Preventive Services Task Force, is more conservative regarding statins. The task force recommends statins for adults who haven’t prior heart attacks only if they are aged 40 to 75, have one risk factor such as diabetes or smoking history, and a 10 percent chance of a cardiovascular event in the next decade.