Experts Issue Tips on Long-Term Statins for Preventive Use

In a recently published report, a group of cardiologists examine the merits of using statins over the long term for preventive purposes in people at high risk for a first heart attack or stroke.

A team led by researchers at Johns Hopkins University School of Medicine offer tips to clinicians on how to evaluate the risks and benefits of long-term preventive use of statins for this patient population. In their report, the authors explain the importance of physicians and patients sharing the decision-making process when weighing the risks of using statins, which already have an established role in secondary preventions for patients who have already suffered a heart attack or stroke.
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For example, physicians and patients must in many cases outline the risks and benefits over the course of multiple office visits, with the initial conversation centering around an examination of the patient’s 10-year estimated cardiovascular risk; the factors contributing to that risk; and therapeutic options, including lifestyle changes and statin therapy, the authors note.

The investigators also analyze the risk-assessment guidance jointly produced by the American College of Cardiology (ACC) and the American Heart Association (AHA). Their recommendations state that statins are considered as preventive therapy when the 10-year risk score for a heart attack or stroke is 7.5% or higher.

The Johns Hopkins-led team, however, notes that these recommendations “leave a lot of room for variation. For instance, the authors say in their report that the decision to start preventive statins—typically as a lifelong therapy—for individuals with high cholesterol but no clinical heart disease should factor in a patient’s likelihood of suffering a heart attack or stroke over the next decade, among several other variables.

The report “highlights the importance of the thoughtful work that primary care physicians are doing every day to personalize treatment plans,” says lead author Seth Martin, MD, assistant professor of cardiology at Johns Hopkins, and lead author of the report.

“The questions of how and when to use statin therapy for primary prevention of cardiovascular case are answered on a case-by-case basis through discussion, not by a formula or computer,” continues Martin. “So the role of the primary care physician is absolutely critical. The time they take to talk to their patients about cardiovascular risk and treatment options empowers patients with necessary knowledge to make the right personal decision.”

—Mark McGraw

Reference

Martin S, Sperling L, et al. Clinician-patient risk discussion. JACC. 2015.