A recent study by researchers at Duke University, North Carolina, and the McGill University Health Centre in Montreal, Canada, determined that the U.S. Preventive Services Task Force (USPSTF) recommendations on statin use were not fully compatible with the guidelines issued by the American College of Cardiology and the American Heart Association (ACC/AHA).

Researchers wanted to compare the 2013 ACC/AHA guidelines to the 2016 USPSTF recommendations to determine if it was possible that there were patients being left out of a correct statin therapy. Results showed that study participants who followed the 2016 USPSTF recommendations for statin use were less likely to be recommended for primary prevention statin therapy.

Overprescribing statins may result in the patient suffering from muscle pain, fatigue, and even an increased risk of diabetes. Image credit: Alamy/Everydayhealth.com

Conflicting views on the same type of drug

The ACC/AHA guidelines would put 26.4 million Americans on statins. These guidelines comprehend a 10-year risk of suffering from cardiovascular disease. Using a risk calculator, anyone older than 40 with a 7.5 percent chance or greater would be told to take statins. The USPSTF recommendations, on the other hand, would only provide statins to 17.1 million Americans.

The National Health and Nutrition Examination Survey indicates that 47.6 percent of Americans 75 years or older use prescription cholesterol-lowering medications. Also, heart disease is the leading cause of death in the United States, making statin use a topic of vital interest.

According to experts in the field, both guidelines use the same basic concepts and evidence, although they may differ in how they interpret each set of circumstances; but instead of determining how many cardiovascular diseases could be prevented, the study showed that both guidelines might exaggerate the benefits of the drug, which could lead to an increase in market prices.

In past studies, researchers determined that using statins had no effect regarding lifespan, meaning that, even if statin use could prevent heart attacks and strokes, studies not considered by the USPSTF or the AHA did not show a reduction in mortality.

What are the recommendations?

The USPSTF recommendations dictate that people who use statins should be aged between 40 and 75, and should be at risk of suffering one of more cardiovascular diseases. Also, they should also be correctly assessed for dyslipidemia, which refers to an abnormal amount of lipids in the blood.

Contrary to what studies may suggest, the USPSTF recommendations claim that low-to moderate-dose statins reduce the risk of suffering cardiovascular events and mortality “by at least a small amount.” They also argue that moderate doses of statins could not be associated with severe conditions, such as cancer or liver disease.

The incidence of cardiovascular disease-related events appears to increase linearly with its risk factors, which goes to show that there is no precise measurement as to when the patient gets the greatest benefit when taking statins. Image credit: Medpage Today.

The difference comes when diabetes is taken into account, with a single trial suggesting a risk of developing diabetes while under a high-dose statin treatment.

A risk calculator designed by the ACC/AHA is available here.

Perceived risks, outside of guidelines and recommendations

Doctors commenting the study only referred to patients being better off discussing with their physician about taking statins or not, although some of them did feel uncomfortable with different sets of guidelines “floating out there.”

A common side effect of statin use is muscle pain, although studies have shown that patients taking a placebo can also develop muscle pain. Only in extreme cases, muscle pain due to statin use can become lethal, turning into liver damage and kidney failure. The risk is increased when taking statins alongside other drugs.

Physician, medication, drugs
According to Reuters, doctors that were not involved in the study agree that there should be a mediating entity for aggregating recommendations and guidelines on something as delicate as drugs to prevent heart disease. Image credit: USC University of Southern California.

Another well-known side effect of statins is neurological side effects, including memory loss and confusion. Studies claim that these symptoms cease after the patient has stopped taking statins. On the other hand, there are studies that suggest otherwise, that statins may help patients with dementia and other mental health problems.

In general, doctors advise being wary of any other drug that’s taken alongside statins, as other cholesterol medicine may react with the statins. Statins can also react badly with grapefruit juice, as it contains a chemical that impedes its metabolization.

Source: The JAMA Network