Statins May Not Be Best Medicine for Everyone at Risk for Heart Disease

Lifestyle choices could be the best prevention for people with lower risk of cardiovascular illnesses.


Cardiovascular disease is common in the United States — so common, in fact, that one out of every four deaths in the country is linked to heart disease.

Physicians have long used statins, a class of lipid-lowering drugs, to treat those who are at risk.

This medication class is one of the most commonly prescribed on the market, amounting to billions of dollars in annual sales in the United States.

But while they’ve proven to be effective for some patients, new research suggests that the medical community is overprescribing statins and should instead only use them for people who are at an increased risk.

What’s more, the most effective treatment for most people isn’t a drug at all — it’s good, old-fashioned healthy living.

Researchers from the University of Zurich published their findings this week in the medical journal Annals of Internal Medicine.

The researchers noted that many guidelines recommend statins for people whose 10-year cardiovascular disease risk is the in 7.5 to 10 percent range.

They evaluated patients in this category.

For men as well as women across various age groups, the researchers concluded that the risks of statin therapy consistently outweighed the benefits.

While statins were still found to be effective for patients with higher cardiovascular disease risk thresholds, researchers concluded that those in the lower ranges are probably best off without statins.

Recent guidelines

The researchers noted that recently updated American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend high-intensity statins only for those who are at a high risk for cardiovascular disease risk.

“The guidelines are actually in line with this editorial,” Dr. Andrew M. Freeman, a cardiologist and director of cardiovascular prevention and wellness at National Jewish Health, told Healthline.

“The bottom line is that the guidelines are evolving,” he said. “They’re still using risk-based estimates like they’ve done since 2013, but now they’re shifting toward being more judicious with that news, which is basically what this paper is suggesting.”

So if those who aren’t at a significantly high risk of cardiovascular disease should avoid statins, what’s the best course forward?

“Lifestyle, in the form of diet, exercise, stress relief, and connection and support with others, is nature’s best way to improve overall health, including cardiovascular health,” said Freeman. “We know that making dietary interventions, combined with exercise, can sometimes lower cholesterol as effectively, or even more effectively, than statins.”

In short, the best therapy to first try what every doctor recommends to their patients: stay active, exercise, and eat right.

It’s tough to know how high-intensity statins compare with an intensive lifestyle approach, but lifestyle changes are a good place to start.

“No one’s really done a trial to compare them head-to-head, so I don’t know the exact answer there,” said Freeman. “But it appears that lifestyle medicine is here to stay and it seems to have a major impact on lipids, so now we’ve just got to get people to apply it in their day-to-day practice.”

Where to begin?

“It’s great to say that everyone should do lifestyle medicine and everyone should eat better,” said Freeman. “A lot of doctors say to patients, ‘You should eat better, you should exercise more, see you later,’ and of course they come back and they’ve done none of it.”

Indeed, anyone who’s ever tried to make these changes in their life can attest to how difficult it can be.

Compounding things is the fact that while physicians, and cardiologists in particular, are experts in their field, most of them have little training in terms of these lifestyle changes.

Freeman notes several ways that physicians can help nudge their patients in the right direction.

One is to serve as a positive role model.

A national program, Walk with a Doc, encourages doctors and patients to go on regular walks. Besides serving as valuable exercise, this also allows patients to learn from doctors outside of the formal setting of the clinic.

Another approach is for doctors to have a discussion with their patients as opposed to lecturing them.

“A very interesting shift in the latest guidelines is that they now are asking for patient-centered discussion about whether or not it makes sense to use a statin,” said Freeman.

Continuing on this theme, Freeman asks patients if he can talk with them about lifestyle changes, rather than talking at them.

“I try to get their buy-in before telling them to stop eating hot dogs and cheeseburgers,” he said. “And then I talk to them, counsel them and give them materials. It’s hard to tell someone, ‘You need to change your lifestyle, see you later.’ It’s better to say, ‘Hey, you need to change your lifestyle, and here are some resources to support you doing that.’”

Freeman says that he also uses motivational tactics with patients.

If they say that they want to be able to dance at a grandchild’s wedding, or simply be athletic into old age, these desires can serve as a motivational carrot to help them achieve their goals.

Another option for patients — one their doctors can help guide them toward — is finding support groups for cardiac rehab and healthy eating.

Overall, says Freeman, it’s a team effort.

While these lifestyle changes have to happen on an individual level, that doesn’t mean patients should have to go it alone.

“I’m a big fan of overall team-based practice,” he said. “Advanced practitioners, nurse practitioners, physician assistants, registered dietitians, health coaches, exercise physiologists, the entire team can help reinforce these messages, and the more time somebody hears the message, the more likely it is that it’ll stick.”

“Every little bit helps, and I think if we can get people steered on the path toward wellness, we’re going to change the way we provide healthcare in this country,” he added.

The bottom line

For most people, lifestyle changes are probably better than statins to prevent cardiovascular disease.

New guidelines and new research suggest that only people with a high risk of cardiovascular disease should be prescribed statins.

Experts say eating healthy, exercising, and getting adequate rest are probably better treatment options for people with lower cardiovascular health risks.

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