New recommendations for the use of statin medications have been issued the U.S. Preventive Services Task Force.

Statins are a class of lipid-lowering drugs that have been found to reduce cardiovascular disease and mortality in those who are at high risk. Statins act by competitively inhibiting HMG-CoA reductase, the first committed enzyme of the mevalonate pathway.

In guidelines published in JAMA, the U.S. Preventive Services Task Force (USPSTF) recommends starting the use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of cardiovascular disease (CVD) who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater (B recommendation).

The USPSTF recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10% (C recommendation).

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older.

“People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke,”

said task force chair Kirsten Bibbins-Domingo, speaking to the Washington Post .

The new recommendations are in line with those from the American Heart Association and the American College of Cardiology. The consensus has now shifted from suggesting doctors pay most attention to the level of a patient’s low-density lipoproteins or “bad cholesterol”, to having a bigger picture view of risk based on multiple factors such as weight, blood pressure, and lifestyle factors.

A link between cholesterol and cardiovascular disease, known as the lipid hypothesis, has been suggested. Cholesterol is the main constituent of atheroma, the fatty lumps in the wall of arteries that occur in atherosclerosis and, when ruptured, cause the vast majority of heart attacks.

Statin Interactions

Commonly prescribed statins include Lipitor, Crestor and Zocor. Statins are prescribed to patients with hardening of the arteries, or atherosclerosis, and those at high risk for developing atherosclerosis, making it likely that statins will be prescribed in combination with other heart disease medications.

The American Heart Association released a statement on the safety of statins in October, taking the position that risk of interactions between statins and other heart disease drugs in patients with heart disease can be managed or reduced. Patients were also urged to inform healthcare providers about all medications they are currently taking and ask if any of those drugs are known to interact with their cholesterol -lowering medications.

“Healthcare providers and their patients who take statins need to be aware that these medications could interact with their other heart disease medications, such as medications to control blood pressure, treat abnormal heart rhythms, and others,”

said Barbara S. Wiggins, Pharm.D., chair of the writing committee of the new scientific statement published in the American Heart Association journal Circulation.

US Preventive Services Task Force Statin Use for the Primary Prevention of Cardiovascular Disease in Adults JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450

Image: Atorvastatin bound to HMG-CoA reductase. By A2-33 CC BY-SA 3.0

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