Surely it´s not the "patient's preference is what matters most" but the available hard medical evidence! I am disturbed by this "let the patient decide"-attitude, surely it is upon us doctors to advice the layperson-patients on this issue!
New ACC/AHA Guidelines Make 12.8 Million More Adults Eligible for Statins — Physician’s First Watch
New ACC/AHA Guidelines Make 12.8 Million More Adults Eligible for Statins
By Larry Husten
Millions more people are now eligible for statin therapy under the 2013 guidelines from the American College of Cardiology and American Heart Association, a New England Journal of Medicine study finds.
Extrapolating data from a representative sample of the U.S. population, researchers calculated the number of adults aged 40 to 75 who would be eligible for statin therapy under the old guideline and the new one. Among the findings:
Under the old guideline, 43.2 million adults (37.5% of the population) were eligible for statins.
Under the new guideline, this increases to 56 million (48.6%).
The net increase of 12.8 million comes mostly from primary prevention, and mostly in adults aged 60 to 75.
The increased number of statin users would result in 475,000 fewer cardiovascular events over 10 years, the authors estimate.
Harlan Krumholz, a cardiologist with NEJM Journal Watch, commented: "The guideline recommendation is intended to be just that — a recommendation about a threshold that might make sense to use in a treatment decision. The guidelines are clear that the patient's preference is what matters most. So it is really impossible to know if more people will be taking statins."
Adapted from CardioExchange
Reader Comments (5)
I have great concern over the new recommendations which are driven by a risk calculator that puts so much emphasis on age alone. As the article points out nearly 80% of adults age 60-75 will meet the criteria for taking a statin. While many in this age group carry numerous other risk factors for CV disease (diabetes, HTN, obesity, etc.) and clearly benefit from statin therapy, I have a hard time with the idea of putting potentially millions of older adults who except for age would have a 10 year risk less than 7.5% on life long statin therapy. And I don't think we have clear data for that decision. To my knowledge there is not data looking at age as an isolated risk factor for CV disease in the absence of other risk. My only conflict of interest here is the fact that in a few years I'll be 60! Currently my 10 year risk is below 5%, but if I run the calculation changing only age I'll be above the 7.5% threshold and qualify for a statin. I'm normotensive, not diabetic, good weight, don't smoke, physically active and otherwise healthy. I don't see myself going on a statin unless other factors change.
Considering the side effects and the new emphasis on lifestyle and not Lipid numbers and the economic issues of the time why are we pursuing this direction. The assumed decrease in deaths is a computer generated number a d does not account for the many variables concerning CV disease
Dear NEJM : You require that the code given below should be written by the reader. Fine ! but you further clarify that this exercise is " --for testing whether you are a human visitor..." ??? Do non-human aliens also hack into this message ? It would be exciting to know please !
There seems to be no mention of adverse effects. How many more people will the new guidelines harm? The last time I attended on the wards at a VA hospital, I had 2 patients on my service on hemodialysis for rhabdomyolysis due to statins. It is concerning that much of the increase in statin use will be for primary prevention. What ever happened to diet and exercise? What ever happened to 'do no harm'?