Recently issued recommendations will significantly change how doctors assess and manage cardiovascular risk and will increase the number of people for whom cholesterol-lowering statin drugs are recommended, studies published on Monday in JAMA suggest.
The recommendations were issued jointly in March by the American Heart Association, the American College of Cardiology, and other major organizations.
Instead of looking at a person’s risk over the next 10 years, starting at age 40, doctors are now advised to consider the patient’s risk over the next several decades, starting at age 30.
Previously, doctors generally advised people with high cholesterol in their 30s and 40s to focus on diet and exercise.
Now, people who are generally considered to be at low risk in the shorter term, meaning they are under 3% risk of having a heart attack or stroke within 10 years, but at modest risk — over 10% — within 30 years, will be advised to start taking statins.
Furthermore, treatment targets for “bad” low-density lipoprotein (LDL) cholesterol have been lowered to 70 mg/dL for most patients without a history of cardiovascular events and to 55 mg/dL for high-risk patients.
In one new study, researchers estimated that as a result of the lower LDL targets and longer-term risk assessments, cholesterol-lowering statin drugs will likely be recommended to an additional 21.5 million Americans, bringing the total to 87.5 million, or 56.6% of adults ages 30 to 79.
“The shift to a longer view of cardiovascular disease risk is a sea change for doctors in counseling patients,” study leader Dr. Timothy S. Anderson of the University of Pittsburgh said in a statement.
“Observational evidence suggests the longer people are exposed to high levels of inflammatory cholesterol molecules, the greater their downstream risks of heart attacks and strokes are,” Anderson said.
“Unfortunately, we do not have randomized clinical trials for low-risk people 30 years out that would directly support this new understanding of how risk builds more gradually over the years,” he said.
Ultimately, he added, patients should talk to their doctors about balancing the potential for modest cardiovascular risk reduction against the potential for adverse drug events and costs.
“For patients seeking to fully minimize risks of heart attacks and strokes, early statin therapy may be a good choice,” Anderson said.
An accompanying study by a separate team estimated that the proportions of U.S. adults with LDL levels above the new targets are 9.9% among low-risk adults, 63.6% among borderline/intermediate-risk adults, and 82.7% among high-risk adults.
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