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A study published on Monday argues against the idea that as many as 40 percent of Americans should take statin drugs to reduce the risk of heart disease. The study in the Annals of Internal Medicine argues that current medical guidelines have not sufficiently considered the risks of these widely used drugs.
"Some damage is mentioned, but it is completely unclear how they were When drafting the recommendations was taken into account," says Milo Puhan, physician and epidemiologist at the University of Zurich and senior author of the new study. "In our approach, we have considered the damage very explicitly."
It is important to know that statin drugs are generally safe and damage is rare. On the other hand, the benefits are not that great either. Over 50 to 200 healthy people need to take a statin every day to prevent a single heart attack for five years, so even minor damage can outweigh the potential benefits, say Swiss scientists.
The most common side effect of these medications is muscle pain, which usually disappears when patients stop taking the medicine. People who take statins also have a higher risk of developing diabetes, which is more difficult to reverse.
Puhan also found that some statins were more effective than others, with atorvastatin (the generic name for Lipitor) being the best in the group. He notes that doctors' guidelines generally do not compare the relative value of these drugs, which are all available as cheap generic drugs.
He also notes that the benefits diminish with age as the damage increases. "Older people do not benefit as much as previously thought," he says.
"One size fits all," he concludes. "This is a very important message."
Puhan says that based on his assessment, 15 to 20 percent of older adults should take statins – far less than the 30 or 40 percent suggested in current medical guidelines.
"I think of myself as a doctor," says Ilana Richman, an internist at the Yale School of Medicine. "These data suggest that it may be reasonable to give more weight to the potential of adverse events Risk. "
She co-wrote an editorial on the newspaper, expecting physicians to spend more time talking about the confusions and disadvantages of statin treatment, and personalizing their referrals more than they do now. She says it's a challenge to convey these sophisticated concepts in the short time physicians spend with their patients.
However, this kind of dialogue is increasingly becoming the expectation. In mid-November, the American Heart Association and the American College of Cardiology released new guidelines to discuss more specifically who would benefit most from statins.
Scott Grundy, a physician at Southwestern Medical Center, University of Texas, led the policy committee and says the new recommendations encourage people in this gray area to get a special type of CT scan that searches for calcium deposits in cardiac arteries, a signal for blockages that could cause problems.
"If you do not have coronary calcium, your chances of having a heart attack in the next 10 years are very low," he says.
And it turns out that perhaps 40 percent of people identified as candidates for their risk factors, such as cholesterol and age, actually have clear coronary arteries, Grundy says. "This means that many people are treated unnecessarily if they do not have a calcium scan."
But the test, which according to Grundy is available for about $ 100, is controversial among some physicians. They fear that there will be an over-treatment of the conditions that the scan picks up but that do not require urgent attention.
And it is only suitable as a screening test for people who did not have heart disease. Statins are routinely prescribed for people who have had a heart attack or stroke. For the patients (who were not included in the Swiss analysis), the benefits are so clear "it is almost mandatory to take a statin drug," says Grundy.
He contradicts many details of the Swiss study. The same applies to cardiologist Roger Blumenthal, who heads the Ciccarone Center for Heart Disease Prevention at John Hopkins. "The damage [analyzed in the paper] can be treated by a smart clinician," he says.
Both the new guidelines and the latest study, however, agree on one important point: physicians and patients should devote more time to studying the benefits and risks of statins, paying attention to the particular circumstances of each individual.
You can contact NPR Science Correspondent Richard Harris at firstname.lastname@example.org.