DR. MOHLER: New statin guidelines, part 2: The bad news | PostIndependent.com
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DR. MOHLER: New statin guidelines, part 2: The bad news

Last week, we looked at the newly released American College of Cardiology and the American Heart Association statin guidelines. Good news: No more target cholesterol levels. And you should get rid of your Zetia and Vytorin that reduce cholesterol levels, but do not prevent heart attacks or strokes.

Then, suddenly the recommendations get murky. They suggest that we should know our “risk” of heart attack and stroke, rather than our “cholesterol number.” Included with the guidelines is an online calculator, (http://my.americanheart.org/cvriskcalculator) that considers gender, age, race, total cholesterol, HDL (good) cholesterol, blood pressure, treated or not, diabetes, and smoking. This is a tool for use by healthy persons who do not have known heart disease or diabetes, are 40-75-years old, and whose LDL cholesterol is 70-189.

Three days after the guidelines were released, two physicians from Brigham and Women’s Hospital in Boston presented robust data in the medical journal Lancet that demonstrated that the risk calculator over diagnosed heart attack and stroke risk by 75%-150%. Uproar! This guideline tool could result in more than 45 million middle-aged Americans who do not have cardiovascular disease being recommended for consideration of statin therapy. Surprisingly, the Heart Association and the cardiologists refused to back down or relook at their calculator. Calculator Credibility Collapsed.



Confused?



MY TAKE

Do not use the cardiovascular risk calculator! It will lead you to drink, or worse a statin. Instead, keep in mind this analysis done by Dr. Abramson in the British Medical Journal in October 2013. For people at low risk of a heart attack or stroke, 140 must take a statin for five years to prevent one heart attack or stroke. So 139 of 140 low-risk patients who take a statin for five years, will receive absolutely no benefit, but are subject to the costs and side effects of the statin. And what are the risks? One out of every five patients will have some ill effect from taking a statin.

These guidelines comment repeatedly that statins are a very safe class of drugs. My clinical experience and formal studies suggest otherwise. Eighteen percent of statin patients experience side effects, including muscle pain or weakness, decreased memory, increased risk of diabetes (especially for women) cataracts or sexual dysfunction.

On the other hand, if you have had a stroke or heart attack, have diabetes or have an untreated LDL cholesterol over 190, then the benefits of statins far outweigh the side effects. Talk to your physician about your statin dose and eliminating Vytorin/Zetia.

Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at pjmohler@bresnan.net.


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