The U.S. population is trending older, and as we age, our risk for heart disease increases. We’re on the verge of a serious health dilemma: While the average 65-year-old person can expect to live 20 more years or longer, the prevalence of heart disease cases in the U.S. is expected to increase more than 40 percent by 2030. How do we slow down this rising tide of risk?
To me, the answer is clear: Every adult who is 50 or older with at least one risk factor for heart disease should be on a statin medication.
Statins are the gold standard of treatment for coronary heart disease, especially when paired with healthy lifestyle choices. They’re also approved by the Food and Drug Administration (FDA) as a preventative therapy to slow the liver’s production of cholesterol, thereby reducing cholesterol levels in the blood. Statins are safe and effective, and I firmly believe adults should start taking them well before their senior years, when the risk for heart disease steadily increases.
What’s age got to do with it?
The risk for heart disease increases with age, regardless of how well your blood pressure and cholesterol are controlled. It’s an unfortunate truth of the aging process.
Numerous studies, such as the 2009
JUPITER trial and the 2016
HOPE-3 trial, have shown that older patients with at least one risk factor for heart disease (such as high blood pressure or family history of the disease) can benefit from statin therapy. The FDA has approved statins for lowering cholesterol and reducing the risk for heart attack, heart failure and stroke, even in people without a history of heart disease.
Statins are effective for younger adults to seniors, to prevent heart disease risk. And it’s important to note that heart disease can occur in individuals who, on the surface, seem like the picture of health but despite this are slowly developing plaques in their arteries that lead to heart disease.
3 types of patients who benefit most from statins
If you fall into one of these three key categories, talk to your doctor and seek out treatment with a statin:
1. Adults of any age with genetic or family risk factors
The first type of candidate for use of statins would be somebody who has a very high inherited level of cholesterol, over 190 points. This can happen even if a person is fit and active. I’ve had patients come to me who were healthy but concerned about familial risk. High blood pressure and high cholesterol can run in the family regardless of personal wellness efforts.
Sometimes, we find that their hunches are correct. We’ve prescribed preventative statins to many patients in their 40s or early 50s who might have been oblivious to their risk if they hadn’t been proactive. When this happens, it’s a wonderful feeling for the patient and the provider. We work together to conserve their health and keep them active.
2. Adults of any age with a personal history of heart or blood vessel disease
Every patient in this group should be on a statin. Once a patient has a cardiac event, such as a heart attack or blocked artery, they’re at increased risk for future events. Statins have proven time and again, especially when paired with healthy lifestyle choices, to reduce the risk of heart disease.
3. Adults age 50 or older who have traditional risk factors
Some of the traditional risk factors for heart disease include:
- Family history of heart disease
- Unhealthy lifestyle choices, such as poor nutrition, lack of exercise and smoking
- Having diabetes
- Having high blood pressure or high cholesterol that is not inherited
If you’re unsure whether you’d benefit, you can use an online calculator to estimate your future heart disease risk. If your risk is over 7.5 percent over the next 10 years, you likely would benefit from a statin medication. And even if you have no heart disease history and feel healthy, it’s a good idea to see a cardiologist just to be sure. The cardiologists at MedStar Heart and Vascular Institute diagnose, treat and manage general heart-health issues and complex cardiovascular conditions. We have a large heart team, which gives us the opportunity to collaborate and improve the breadth and depth of each patient’s care. Request an appointment: Call 202-877-3627.
How patients can reduce their risk every day
An optimal lifestyle is far more powerful than any medicine we can prescribe and should be everyone’s primary therapy against heart disease. Statins can reduce the risk of heart disease by nearly 30 percent, but an optimal lifestyle can lower that risk by up to 50 percent. When I say “optimal lifestyle,” I mean patients should:
- Avoid tobacco and excess alcohol
- Eat a healthy diet that is low in saturated fats, low in concentrated sugars, and high in fresh fruits and vegetables
- Exercise 30 to 60 minutes most days of the week
- Know their blood pressure and cholesterol numbers
The risks related to statins are rare and mostly include muscle aches. Some effects have been overblown online and in some public media, such as liver or memory effects. Any muscle aches can quickly and easily be improved by adjusting the drug or the dosage. Statins are extremely safe for the liver. In fact, after initial testing, there’s no medical reason to monitor liver enzymes long-term in most patients who take statins. And when it comes to memory, some research suggests that statins don’t cause memory problems but do reduce the risk of stroke.
Statins are our safest treatment for heart disease—so safe, in fact, that I’ve advocated for statins to become available over the counter. The benefits outweigh the risks, almost without exception. And if a patient can’t tolerate one type of statin, there are multiple variations they can try to find one that works.
A shift in mindset about statins
Recently, more powerful cholesterol-lowering medications have been introduced that have helped change doctors’ general mindset about preventative care. As such, statins are starting to be seen as a broader level of treatment instead of being reserved only for patients with very high cholesterol.
In the future, we’ll see more attention to intensive, proactive cholesterol lowering to decrease the risk of heart disease in the U.S., with statins as the centerpiece. As our population ages, the overall risk in this country will continue to increase. We must be attentive and proactive to prescribe statins to the right patients at the right time.
