Studies show that only 35% of people eligible for statins use them. How do you know if you should be on them?

About 86 million adults in the United States have high cholesterol, a condition that increases the risk of heart disease and stroke. Despite these high numbers, only 35% of American adults who could benefit from cholesterol-lowering medication actually take it.

While many medications can help, a common class of cholesterol-lowering medications are statins. However, if you’re not sure exactly how they work, when to go on them and what the potential side effects are that you should be concerned about then you’re not alone. So what’s the deal with statins and how safe are they? Cardiologists break it down.

How do statins actually work?

The main function of statins is to lower your cholesterol. Dr. Blair Suter, a cardiologist at The Ohio State University Wexner Medical Center, tells Yahoo Life that statins work to block the pathways that make cholesterol in the liver.

Your liver responds to statins by more easily seizing cholesterol particles in the blood, says Dr. Yu-Ming Ni, a cardiologist and lipidologist at Memorial Care Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, which lowers your There is less cholesterol in the blood. , tells Yahoo Life. (High levels of cholesterol in the blood can damage your arteries, increasing your risk of heart attack or stroke, he explains.)

The more cholesterol you have in your blood, the faster it gets incorporated into plaque along the walls of blood vessels, Dr. Alexander C. Fanaroff, assistant professor of medicine in the department of cardiovascular medicine at the University of Pennsylvania, tells Yahoo Life. He says if plaques become too large, they can block blood flow to the heart or brain, leading to a heart attack or stroke. Therefore, lowering cholesterol with statins may help reduce the risk of heart attack or stroke.

Some data also suggests that statins reduce inflammation, Nee says, noting that it may also help reduce the risk of heart attack or stroke.

Who needs statins?

The US Preventive Services Task Force (USPSTF), the American College of Cardiology (ACC), and the American Heart Association (AHA) say that people in the following groups may benefit from statins:

  • People with one or more heart disease risk factors have an increased risk of heart attack over 10 years. This includes people who have diabetes, high cholesterol or high blood pressure, as well as people who smoke.

  • People who have heart related diseases. These are patients with heart disease associated with hardened arteries, who have had a heart attack or stroke due to a blockage in a blood vessel, mini-stroke, peripheral artery disease or surgery to open or replace the coronary arteries.

  • People with high LDL (Bad) Cholesterol. This includes adults with LDL cholesterol levels of 190 mg/dL or higher.

  • Adults suffering from both diabetes and high cholesterol. This includes adults aged 40 to 75 who have diabetes and LDL cholesterol levels between 70 and 189 mg/dL.

Faneroff says statins reduce the risk of heart attack, stroke or cardiovascular death by about 30%. This means that if a person is not taking a statin the 10-year risk is 7.5% and the drug will reduce that risk to about 5%. If a person’s risk is high, such as 25%, statins reduce that risk to about 17%, Fanaroff explains.

Are statins safe?

While doctors agree that statins are safe and most people tolerate them well, some patients are afraid to take them. Suter says people may be concerned about starting a statin because of potential side effects related to liver, muscle and cognitive impairment.

These often stem from a 2012 warning from the Food and Drug Administration that people using statins have reported dealing with a number of health problems, including:

  • Short-term memory loss and confusion that go away when people stop using the drug

  • increased blood sugar levels

  • In rare cases, serious liver problems

But, again, the data has been mixed. Suter says the research regarding all of these side effects has been contradictory and controversial. A 2021 study published in the Journal of the American College of Cardiology analyzed data on statin use in 18,446 people age 65 and older. Researchers found that people who took statins were more likely to develop dementia during the five-year study period than those who did not use the drugs. There was also no difference in memory, language and executive function.

Another study published in the journal Scientific Reports analyzed data from 55,114 people taking statins and compared them with 245,731 people who were not taking the drugs. At the beginning of the study, as well as during two follow-ups within five to 10 years, participants were measured for reaction time, working memory and fluid intelligence (the ability to reason and think flexibly). The researchers found that older people taking statins had better reaction time and fluid intelligence, while younger people had improved fluid intelligence but decreased working memory. As a result, researchers concluded that the effects of statins may vary by age.

As for blood sugar levels, research shows that in patients at high risk of atherosclerotic disease, the hardening of the arteries due to plaque buildup, the benefits of statin use outweigh the risks of new-onset diabetes. That benefit-risk ratio is less clear and should be discussed with a health care provider when it comes to patients who do not have diabetes and have zero or only one risk factor for atherosclerotic disease.

As far as liver disease is concerned, a 2023 study of more than 1.7 million people published in JAMA Network Open found that regular use of statins reduced the risk of developing liver disease by 15% and reduced liver-related The risk of dying from the disease decreased by 28%. The problems were compared with those who did not take the medications. People who regularly used statins also had a 74% lower risk of developing liver cancer.

What are the possible side effects of statins?

Although there are more serious potential side effects that are still being discovered, there are also some minor problems that statin users may experience.

Dr. Samuel Kim, a preventive cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center, tells Yahoo Life that the most common side effect of statins is muscle pain. Kim says this is more common in clinical practice than in large clinical trials. However, Kim says the side effects get better with time and changes in dosage. He says side effects can also include fatigue and increased blood sugar, but these are less common.

Kim says that even for patients with side effects, when they reduce the dose of the statin or re-test the drug after a temporary break, they are often able to tolerate the drug.

Why don’t more doctors prescribe them?

A study published in Annals of Internal Medicine in early December analyzed National Health and Nutrition Examination Survey data from 1999 to 2018 and found that while statin use to prevent cardiovascular problems increased during that time, only 35% of people Only those are eligible for this. Medicines actually use them.

The researchers theorized that many doctors don’t have time to do the multistep risk calculations required to prescribe statins, so they don’t prescribe the drugs. When you give primary care providers hypothetical patient scenarios and ask whether these patients should be prescribed statins, primary care providers closely follow the guidelines and prescribe statins to people who are eligible, Fanaroff says. To me, this suggests that more doctors don’t prescribe statins because they are too busy with small clinic appointments to attend to all of a patient’s needs, and sacrifice preventive care to take care of more urgent concerns. May go.

Fanaroff emphasizes that this is not a case of doctors being lazy. In one study, researchers showed that it would take 26.7 hours for primary care providers to take care of all the acute and preventive needs of patients seen in a single day, which is clearly impossible, he says. Research from our group and others shows that there is promise in involving other members of the health care team, such as nurses and pharmacists, to help prescribe statins to appropriate people.

But Nee says the matter is more complex than the time available. He says misinformation regarding statins abounds. That said, I’ve heard patients complain that cholesterol isn’t important for reducing heart disease, that statins damage the liver and cause dementia and even doctors sell the drug to make money off statins. The companies are in cahoots, none of which is true.

Kim agrees. He says statins have proven to be a very safe drug and are well tolerated by most of the population. There should be a mutual discussion between the provider and the patient about the risks and benefits. Statins are still underused.

Nee emphasizes that statins are also inexpensive. It’s one of the most cost-effective treatments we have to fight the No. 1 killer in America: heart disease, he says.

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