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The American College of Cardiology (ACC) and the American Heart Association (AHA) regularly update their recommendations on who should be treated with cholesterol lowering medications; the most frequently used class is the statin group which includes simvastatin (Zocor), atorvastatin (Lipitor), and rosuvastatin (Crestor) among others. In this article we’ll discuss the current recommendations as of 2019 and when it might be reasonable to stop statin therapy.
How do statin drugs reduce heart attack and stroke risk? In summary, 1) they reduce the bad (LDL) cholesterol which promotes blockages in arteries, 2) they possibly exhibit an anti-inflammatory effect, and 3) they stabilize existing artery blockages and prevent them from rupturing like a volcano – which causes immediate cell death (pleiotropic effects). The goal for most patients is to reduce LDL levels by 30-50%. In higher risk cases, we aim for an LDL less than 70 mg/dL; this includes those with diabetes or existing heart disease.
Experts agree on a few things; for example, the following groups of people should take statin medications:
The catch is that the above guidelines typically apply only to people younger than 75 years of age. Until now, there simply hasn’t been enough data to suggest benefit for those trying to prevent heart disease in their later years. The general recent consensus has been that patients and providers discuss the individual risks and benefits and should consider stopping statins after age 75.
While statin side effects are generally mild, they do become more significant as a person ages. Older patients are also more likely to be adversely affected by cost and potential drug interactions.
There is also mixed evidence as to the effect of statins on cognitive ability later in life. Some research suggests there is a short-term, reversible, decrease in memory immediately after starting a statin–something older patients might be very concerned about. There is also evidence, however, that statin use lowers the overall risk of dementia – showing the conundrum of medication use in older patients.
A recent French study (July 2019) suggests that there is still benefit to statin therapy beyond age 75. This observational study, which is unable to determine causation, showed that those over age 75 who stopped their statins were 1.46x more likely to suffer a heart attack and 1.26x more likely to have a stroke. In real terms, this means that we might expect an extra 2.5 cardiovascular events per 100 people within the first four years of stopping statins at the age of 75 years compared to those who continue taking them. A 2019 meta-analysis in the journal Lancet also concluded that limited evidence supports continuing statin meds in those past age 75; greater benefit of statin use was seen in those younger than 75.
At Treasure Valley Family Medicine, we believe in having these important discussions with patients and their loved ones. We go as far as doubling, and even tripling, the average appointment time of other practices to ensure that this happens.
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Very personable. Knowledgeable. I appreciated his commitment to my care and well being and at the same time balancing the importance of that care with my pocketbook.