Should statins be used for primary prevention?

[Ambivalid]

While nearly no one would dispute the need and efficacy of statins for high-risk patients (those who have had previous heart attacks, etc.), my question is about those for whom the vast majority of statin prescriptions are written: otherwise healthy adults, with no history of heart disease, who simply have high LDL cholesterol levels. Basically, these drugs are given as a primary heart attack prevention treatment.

But as current debate shows, this is far from wholly accepted within the medical community. So my question is, should statins be used in this primary preventative method?

[dolphinboy]

IANAD, but experience tells me yes, the small risk is worth the reward.

I have been taken statins for 20+ years due to elevated cholesterol, and I know a lot of other people in the same boat as me. Diet and exercise (and Niacin) just didn’t do the trick. BTW, I have no history of heart disease in my family.

I think most cardiologists believe that taking statins before a heart problem is better than waiting until after you have a heart attack.

[Ambivalid]

@dolphinboy

IANAD, but experience tells me yes, the small risk is worth the reward.

I think most cardiologists believe that taking statins before a heart problem is better than waiting until after you have a heart attack.

Copied from my link…
Do the potential benefits outweigh the potential risks? Based on all current evidence, a healthy man with elevated cholesterol will not live any longer if he takes statins. For every 100 patients with elevated cholesterol levels who take statins for 5 years, a myocardial infarction will be prevented in 1 or 2 patients. Preventing a heart attack is a meaningful outcome. However, by taking statins, 1 or more patients will develop diabetes and 20% or more will experience disabling symptoms, including muscle weakness, fatigue, and memory loss.
Small risk? Or decent risk and small reward?

[Qadgop_the_Mercotan]

Some patients who have not yet developed heart disease yet are at extremely high risk to do so can be fairly easily identified by current health screening. These folks do indeed benefit from use of statins.

So yes, high risk patients can benefit from statins, and should be put on them for primary prevention. It’s more a question of just where we set the bar. High cholesterol alone is a poor way of deciding, however. But throw in severe poorly controlled hypertension, smoking, diabetes, and a strong family history of premature heart disease along with LDL levels of over 200, and primary prevention is definitely indicated.

Sorry, no time to throw up the cites at the moment.

[Ambivalid]

@Qadgop_the_Mercotan

Some patients who have not yet developed heart disease yet are at extremely high risk to do so can be fairly easily identified by current health screening. These folks do indeed benefit from use of statins.

So yes, high risk patients can benefit from statins, and should be put on them for primary prevention. It’s more a question of just where we set the bar. High cholesterol alone is a poor way of deciding, however. But throw in severe poorly controlled hypertension, smoking, diabetes, and a strong family history of premature heart disease along with LDL levels of over 200, and primary prevention is definitely indicated.

Sorry, no time to throw up the cites at the moment.

But isn’t high cholesterol alone the reason many people have been put on statins?

[DSeid]

Recent related thread.

That 20% number is, to put it mildly, very debatable … hence the debate.

For myself I am staying on a low dose for primary prevention. But the case for doing so for people like me (strong FH of high cholesterol, early heart attacks, diabetes, good BP, good BMI, healthy diet, regular and somewhat intense exercise, off med modestly elevated non-HDL cholesterol and LDL) is far from airtight.

[Qadgop_the_Mercotan]

@Ambivalid

But isn’t high cholesterol alone the reason many people have been put on statins?

I’m sure it has been. But it usually shouldn’t be the sole reason. It should be done based on risk analysis, part of which is based on cholesterol, part of which is based on other factors.

Patients with elevated cholesterol along with any one of the following: known coronary artery disease, peripheral artery disease, symptomatic carotid disease, or abdominal aortic aneurisms definitely benefit from LDL levels under 100.

Folks who are known to have high blood pressure, or have a strong family history in their primary relatives of premature coronary artery disease have greatly reduced risk of premature heart disease themselves if their LDL is under 160.

But I once worked with a 9 year old patient whose cholesterol was over 1200. People with cholesterol levels in that range tend to have their first heart attacks during their teen years, and die by their late 20’s, unless treated.

So sometimes high cholesterol can be the sole reason to treat.

And I agree with DSeid: the data on the frequency and severity of statin side-effects is nowhere near as solid as the beneficial effects of statin for high risk groups.

[Ambivalid]

So how heavily are these other risk factors (family history, lifestyle, weight, etc.) weighed in relation to the risk factor of high cholesterol when deciding whether a patient should be treated with a statin? Are they given equal consideration? For example; you said that in extreme situations, like the 9 year old, high cholesterol alone is reason enough to recommend statins. So would any of these other risk factors, if found alone and in extreme circumstances, be reason enough to recommend statins?

[Qadgop_the_Mercotan]

@Ambivalid

So how heavily are these other risk factors (family history, lifestyle, weight, etc.) weighed in relation to the risk factor of high cholesterol when deciding whether a patient should be treated with a statin? Are they given equal consideration? For example; you said that in extreme situations, like the 9 year old, high cholesterol alone is reason enough to recommend statins. So would any of these other risk factors, if found alone and in extreme circumstances, be reason enough to recommend statins?

At the present time, statins are used virtually exclusively for lowering of LDL cholesterol. While a few hypotheses are bandied about regarding other potential uses, it is really not used for purposes other than lowering cholesterol.

[samclem]

I heard an interesting discussion on NPR’s Diane Rehm’s show on Tuesday.

New Cholesterol Research And Heart Disease Prevention - Diane Rehm

That link is probably a transcript, but you can probably find something to listen to if you choose.