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Published: Tuesday, 11/19/2013

EDITORIAL

Second opinion on statins

Potent cholesterol-lowering medication associated with difficult side effects

Two respected medical organizations say that twice as many of us — nearly a third of all adults — should take statins to avoid heart attack and stroke. But statins, the potent cholesterol-lowering medications of which Lipitor is the most famous brand name, are associated with difficult side effects, notably muscle pain. Once prescribed, they are generally taken for the rest of one’s life.

Last week, the American Heart Association and American College of Cardiology concluded that the drug should be prescribed for people with at least a 7.5 percent chance of having a heart attack within the next decade — a lower threshold than before. The groups devised an online calculator based on factors including age, gender, and cholesterol levels to determine that risk.

But the new advice sparked controversy. There already are complaints that the calculator might overrate people’s risks. Yet it’s hard to imagine a more important public-health topic than preventing heart attacks. Heart disease is the No. 1 killer in this country, and strokes, which statins also help prevent, are a major cause of death as well.

A panel of doctors appointed by the two organizations wrote the report. Some critics accuse it of pushing pills in ways that help the pharmaceutical industry. But the panel, which spent years examining studies on the issue, has been widely praised for recommending that doctors determine their patients’ overall risk of a heart attack or stroke, rather than simply trying to lower cholesterol levels to a preset target.

There’s little evidence, the panel concluded, that lowering LDL, or “bad” cholesterol, to one number for everybody saves lives. Its recommendations also would lead to far less use of some nonstatin cholesterol-lowering drugs, for which the panel found little evidence of reduced heart attack rates.

Another critic of the new recommendations is Marvin Lipman, the chief medical adviser at Consumers Union. He says that although statins are known to reduce fatalities greatly among people who have or are at very high risk of heart disease, there is a lack of hard evidence when it comes to people with a risk of less than 10 percent.

The panel says it now will re-examine its risk calculator. Some experts allege it has flaws that would identify millions of people as being “at risk” when they’re not.

These are the kinds of complicated issues that the U.S. Preventive Services Task Force excels in examining. Before the nation embarks on a radical shift that could double the number of people who take statins, this independent group should deliver a second opinion.

— Los Angeles Times



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