- A new analysis reevaluates statins and who should use them.
- Statins are widely used to help lower cholesterol.
- Using a new analysis, researchers found that millions of people were taking statins they didn’t need.
New research reveals that many people who currently take statins to lower their cholesterol levels may not actually need the medication.
An analysis, published in
Currently, doctors use what are called pooled cohort equations (PCEs) to decide whether a patient needs statins. These equations take into account a series of factors that play a role in heart disease risk. Recently, experts designed a new, more accurate equation called Predicting Risk of Cardiovascular Disease Events (PREVENT).
Researchers found that millions fewer people would meet the criteria for statins, while many more people who are not currently taking statins would become eligible.
Health Line spoke with Cheng-Han Chen, MD, board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California. Chen did not participate in the study.
“Statins are commonly used in clinical practice in two scenarios,” he explained: “first, people who have already suffered a cardiovascular event such as a heart attack or stroke, or second, people with risk factors for developing heart disease.
For those in the second category, “the decision to start a statin depends on our assessment of their risk of developing cardiovascular disease in the future. To help us decide whether someone should start taking a statin, we will frequently use a risk calculator to estimate a person’s 10-year risk of developing cardiovascular disease. This includes equations such as PCE and PREVENT.
Both PCE and PREVENT estimate an individual’s 10-year risk of developing atherosclerotic cardiovascular disease. Atherosclerosis is a disease in which plaque builds up inside the arteries, slowly narrowing them and interrupting blood flow.
PCE calculations are the current standard, but they are based on data that is decades old and lacks diversity. However, the new PREVENT equations were released by the American Heart Association (AHA) in
PREVENT includes new variables, such as renal and metabolic function and statin use. Additionally, it no longer includes race. Overall, experts believe these changes make the tool more accurate.
To study how PREVENT works, scientists extracted data from the National Health and Nutrition Examination Survey from January 2017 to March 2020. This nationally representative data included information from 3,785 adults aged 40 at 75 years old.
After analyzing the numbers, there are significant differences between the PCE and PREVENT estimates.
First, looking at the entire group of participants, the PCE estimated the 10-year risk of developing atherosclerotic cardiovascular disease to be 8%. With PREVENT, this figure fell to 4%.
These changes were more pronounced among Black people and adults aged 70 to 75. For Black people, the overall risk in the entire cohort fell from 10.9% to 5.1%. Among 70-75 year olds, it went from 22.8% to 10.2%.
They also found that if PREVENT were rolled out nationally, the number of people meeting criteria for statins would decrease from 45.4 million to 28.3 million.
“In other words,” the authors write, “17.3 million adults recommended statins based on PCEs would no longer be recommended statins based on the PREVENT equations, including 4.1 million adults currently taking statins. »
They also found that 15.8 million people who are not currently taking statins could actually benefit from these drugs.
Although the changes seem dramatic, Chen said Health Line that they are “consistent with previous analyzes which indicated that the old model seemed to overestimate risk”.
If PREVENT is rolled out widely, physicians will need to communicate changes carefully. Patients who may be discontinuing medications may be confused and worried. Patients who may need to start taking statins may wonder why their risk has changed.
“We don’t want people to think they’ve been treated poorly in the past,” said one of the study’s authors, Dr. Timothy Anderson, MD, of the University of Pittsburgh, Pennsylvania. “They were processed with the best data we had when PCE was introduced in 2013. The data has changed.”
He also notes that because everyone’s risk tends to increase with age, some people may stop taking statins and eventually return to them.
“For a patient who we now know is at lower risk than we previously thought, if we recommend that they stop taking statins, they could still return to higher risk in 5 years, for the simple reason that the risk for everyone increases the higher the risk. we’re getting older,” says Anderson.
Health Line spoke with Donald M. Lloyd-Jones, MD, chair of the Department of Preventive Medicine and professor of preventive medicine, cardiology, and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois.
We asked Lloyd-Jones, who was not involved in the study, whether the PREVENT equations are more accurate than the PCEs:
“They are clearly more specific and precise. The PCEs were calculated on 30,000 people, some from older birth cohorts who did not live in contemporary conditions (different exposures to food, smoking, etc.). PREVENT was developed on a much more contemporary sample of approximately 3.2 million adults and validated in 3.3 million different U.S. adults.
We also asked if PREVENT would be rolled out across the United States. “It will depend on the steering committees of the AHA and the American College of Cardiology,” he explained.
As they evaluate the tool, “clinicians can now use them – on the AHA website, for example – with confidence in their precision and accuracy.” »
New research reveals that millions of people on statins may not need to take the drugs.
The researchers reached this conclusion after updating the method for assessing an individual’s risk of heart disease over 10 years.