At 40, It May Be Time For a Cholesterol-Lowering Drug

Statins and stethoscope. (Shutterstock Photo)
A UConn Health cardiologist discusses new prevention guidelines that could dislodge heart disease as the #1 killer of Americans. (Shutterstock Photo)

Cardiologist Dr. Peter Schulman, who specializes in preventive cardiology at UConn Health’s Pat and Jim Calhoun Cardiology Center, explains the newly broadened statin medication guidelines of the U.S. Preventive Services Task Force. It is now urging initiation of the cholesterol-lowering drug at age 40 to prevent cardiovascular disease and its risks of heart attack and stroke.

Q. What are statins and how do they work?

A. Statins are drugs that block the key enzymatic step in the formation of cholesterol. As a result, the body makes less cholesterol, less cholesterol circulates in the body, and less cholesterol gets into the arterial wall. Fewer arterial blockages occur. This reduces the risk of heart attack and stroke.

Q. What is the task force now recommending?

A. The new recommendations now apply the use of statins to an expanded group of patients. It is now recommended that patients ages 40 to 75 without any sign of heart disease, but who have a major risk factor of smoking, diabetes, hypertension, or elevated cholesterol to be considered for a statin drug. Previous 2013 guidelines used a risk calculator based on statistics from the American Heart Association. However, some experts feel that those statistics overestimate the actual risk of a heart attack.

Q. How significant is this new recommendation and what impact could it have on heart disease and heart attack prevention?

A. If future data confirm the validity of the new guidelines, it’s conceivable that heart disease will finally drop from being the number one leading killer of Americans. From the year 1900 until 2016, heart disease has killed more Americans than any other disease. There was one exception in 1918, the year of the “Spanish Flu.” Cancer is poised to become the leading killer in the future.

Q. How are the new recommendations in contrast with the American Heart Association guidelines?

A. Compared to the prior guidelines, the new guidelines expand the group that is recommended for statin therapy. It remains to be seen how doctors will deal with this. Many doctors were skeptical and remain so about the “aggressiveness” of the 2013 guidelines when they were published, and the 2016 guidelines are even more aggressive. However, research data that came out last year, after the 2013 guidelines were released, seem to support the aggressiveness, showing that patients given statin drugs had a lower risk of heart attacks.

Q. What do you recommend patients 40 and older do next?

A. Patients should talk to their doctor. The new information comes in the form of guidelines that can assist physicians and patients in the management of medical conditions. But if you’re a patient who has a doctor that relies solely on guidelines and nothing else for treatment decisions, then you should find another doctor.