Monday Medical: Older than 40? Consider a statin
February 26, 2017
Editor's note: This article is the third in a three-part series on heart health for American Heart Month.
If you're older than 40 and you're not currently taking a statin, you might want to reconsider.
In late 2016, the U.S. Preventive Services Task Force issued new guidance for the use of statins, or medications that help lower cholesterol and reduce cardiovascular disease. The new recommendations suggest everyone older than age 40 be screened to see whether a statin could be beneficial, regardless of whether they've had a history of cardiovascular disease.
"It's a pretty broad recommendation," said Dr. Jason Jurva, a cardiologist with YampaCare Cardiology. "Virtually everybody middle-aged and above ought to be considered for taking a statin. That's a big change, and it's hard for people to appreciate the fact that they need to be on a medication for cholesterol."
Cholesterol is a fat-like substance found in the all cells of the body. The body makes all the cholesterol it needs, and since cholesterol is also found in some foods, it's easy to get too much.
HDL cholesterol, or high-density lipoproteins, is known as "good" cholesterol and works to take cholesterol in the body back to the liver, where it is removed. LDL cholesterol, or low-density lipoproteins, is known as "bad" cholesterol, as it can build up in the arteries and result in heart disease. The body needs both types of cholesterol — the problem is when there's too much.
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Statins prevent the liver from making cholesterol and help improve the removal of cholesterol and, accordingly, can significantly reduce the risk for heart attack and stroke.
"Statins are the one surefire way of reducing your risk of having a heart attack," Jurva said. "We know that if you start these drugs early, you could be preventing heart attacks 20 or 30 years down the road."
People who have healthy cholesterol levels, don't smoke, maintain a healthy weight, eat a healthy diet and exercise regularly may not need to take a statin. But studies show less than 4 percent of the population hits all those thresholds.
That means that most men older than age 40 could benefit from taking a statin. Statins are also helpful for women, though women may not need to start statins until a later age.
In the past, doctors have recommended dietary changes first to combat high cholesterol. But since most of the cholesterol in the body is made in the liver, those dietary changes typically aren't enough to decrease risk of heart attack and stroke. Even with aggressive lifestyle changes, such as eating a healthy diet and engaging in regular exercise, most people can't lower their cholesterol more than about 15 percent.
Statins, however, can result in a lowering of LDL by 30 to 50 percent.
The sooner people start on a statin, the more benefits they stand to realize.
"It's like compound interest," Jurva said. "The longer you're on it, the better benefit you get."
There are possible side effects of statins, though they're usually minor, such as some aches and pains. Statins have been used for decades, and a large body of data supports the claim that side effects are minimal.
"The side effects are far overblown," said Jurva, referring to the negative press statins can get in blogs and other online sites. "Real side effects compared to placebo are very similar."
And the benefits of statins are great.
"We're not just aiming for cholesterol anymore," Jurva said. "We're actually trying to reduce the risk of future heart problems."
With heart disease still the No. 1 cause of death in America, statin use is all the more important. And Jurva is quick to point out that he follows the recommendations, too.
"I took my statin last night," he said.
Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.