The ASCVD Risk Calculator Risk Calculator Even if you don’t seem to have a major heart disease risk factor, you may still be a candidate for statin therapy. To estimate the 10-year risk of heart attack or stroke in people without known cardiovascular disease, the American Heart Association developed the Predicting Risk of Cardiovascular Disease Events (PREVENT) calculator . This calculator utilizes equations based on data from more than 6.5 million U.S. adults, and takes cardiovascular, kidney, and metabolic factors into consideration.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c61c509-86e7-4f83-b24e-ab583b378db0 To generate a risk score, the calculator asks for the following information:e60dc2a1-f33c-4a05-9b50-8e3e8e597629dc5e85ec-8fcf-4283-8d1e-784d4c4b56b9 Sex Age Systolic blood pressure (the top number in a blood pressure reading) Total and high-density lipoprotein (HDL) cholesterol Estimated glomerular filtration rate (a blood test that measures kidney function) Body mass index (BMI) Smoking status History of diabetes, statins, and medications for high blood pressure The calculator also offers the option to input urine albumin-to-creatine ratio (uACR), which is a urine test that detects early kidney damage; hemoglobin A1C , a blood test to diagnose and monitor diabetes; and even zip code, to account for the increased health risks associated with living in a community with limited resources. “A higher ASCVD risk score and additional factors such as family history and chronic inflammatory illness can help determine if statin therapy would be an appropriate recommendation,” Dr. Gaznabi says.
The Takeaway Statins are medications that lower LDL (“bad”) cholesterol, reduce inflammation, and help prevent heart attacks and strokes. Many eligible patients avoid using statins, which could be leading to preventable cardiovascular deaths and hospitalizations. Current guidelines recommend statins to adults with a known high risk of future heart events, high cholesterol, established cardiovascular disease, and diabetes or other chronic diseases. While concerns about side effects are common, research shows most are rare or overstated. Most experts believe that for the majority of people, especially those at higher risk for heart disease, the benefits of statins outweigh the potential downsides.
Statin Side Effects: The Reality Side Effects Many people avoid statins out of concern about unwelcome side effects, such as muscle pain, liver damage, and memory loss or confusion.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab257b48-4478-458d-8d7d-8ea2053e333c It’s possible that the fear of statin side effects is exaggerated. One recent meta-analysis of data from 23 large-scale randomized studies revealed that statins don’t cause the majority of the side effects listed in the product packaging. And muscle pain, the best-known statin side effect, only impacted roughly 1 percent of users.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d98b9a38-045c-49a5-a654-35c8d655e408 Miller says if you do experience muscle pain, it should resolve within a week of stopping the statin. “Statins are safe,” Miller says. “Does that mean that everybody that takes a statin is going to be free of side effects? Of course not.” Those who don’t tolerate statins well may also switch to less frequent dosing — every other day instead of daily — and still see reductions in LDL, Miller says. In addition, there are other medications to try, such as ezetimibe (a non-statin pill that reduces the amount of cholesterol absorbed from food) and PCSK9 inhibitors (injectable medications that help the liver remove LDL from the blood).e60dc2a1-f33c-4a05-9b50-8e3e8e5976290e3273d4-6269-453c-9cfc-2ee1dff89c68 “I encourage all patients to address their concerns with their healthcare providers so we can find the right recipe for them,” Gaznabi says.
Statins: The Official Recommendations Statin Recommendations Statins are medically indicated for adults with high cholesterol, established cardiovascular disease, diabetes or other chronic diseases, or a high calculated risk of future heart events. “Statins are most useful in those patients at the highest risk of having a cardiovascular event, either initial or repeat events,” says Michael Miller, MD , a Philadelphia-based cardiologist at Penn Medicine who specializes in preventive cardiology and a coauthor of The American Medical Association Guide to Preventing and Treating Heart Disease . The American College of Cardiology (ACC) and American Heart Association (AHA) recently updated their guidelines on managing and treating abnormal levels of cholesterol and triglycerides in the blood. This condition is known as dyslipidemia, and it increases the risk of cardiovascular disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762952c3b824-3ecc-4b93-9343-3bb1db846985 But not everyone with dyslipidemia needs a statin or the same dose. The guidelines lay out clear criteria for who should be considered for statin therapy and at what intensity.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915105eef-131c-4dc4-89d3-6a21240388fd Primary Prevention Even if you have no known heart disease and normal cholesterol levels, you may still be a candidate if a risk assessment tool estimates a high probability you’ll have a heart attack or stroke in the future. High Cholesterol Statins are the primary treatment for those with an LDL of 190 milligrams per deciliter (mg/dL) or higher or a triglycerides level of 150 mg/dL or higher. Chronic Disease People ages 40 to 75 with diabetes , chronic kidney disease (stage 3 and higher), or human immunodeficiency virus (HIV) are typically prescribed moderate-intensity statins. Established Cardiovascular Disease A high-intensity (higher dose) statin is recommended for those who already have atherosclerotic cardiovascular disease (ASCVD). Subclinical Atherosclerosis People with plaque buildup but no chest pain or shortness of breath, which is known as subclinical atherosclerosis, are also prescribed statins, but the intensity and dosage varies depending on the severity of calcium buildup in the arteries.
What Are Statins? What Are Statins? Statins are medications that help improve low-density lipoprotein (LDL) , also referred to as “bad” cholesterol, a well-established risk factor for cardiovascular disease. They work by reducing cholesterol production in the liver, and they’re available in different doses, from low to high.e60dc2a1-f33c-4a05-9b50-8e3e8e597629742d3f8c-01a9-4e77-afed-277adc279730 “Statins stabilize plaque in the arteries so it is less likely to rupture, they reduce inflammation in blood vessels, and they improve overall blood flow and vessel function,” says Sadeer Al-Kindi, MD , a preventive cardiologist and an assistant professor of cardiology at Houston Methodist in Texas. “Because of these effects, statins can help prevent heart attacks and strokes, even in some people whose cholesterol levels are not very high.”
If your doctor suggested you take a statin but you’re not following that advice, you’re not the only one who isn’t filling that prescription. Many people who are candidates for these popular cholesterol-lowering drugs are reluctant to take them for fear of side effects , a preference for lifestyle modifications, or a general aversion to taking prescription medications.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fb26c96a-d1b5-4f9c-ad31-6f3631266c76 But some experts believe this treatment gap may result in tens of thousands of preventable heart attacks , strokes , and surgeries.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292fa9ac61-0b85-40cb-89ed-9cfdf6c07bd9 If you’re at risk for developing heart disease, it may be worth learning more about the potential benefits and downsides associated with taking statins.
Resources We Trust Cleveland Clinic: 7 Ways to Lower Your Cholesterol Johns Hopkins Medicine: How Statin Drugs Protect the HeartAmerican Heart Association: Cholesterol-Lowering MedicationsHeart Foundation: Know Your Risk: Family History and Heart DiseaseColumbia University Irving Medical Center: Statins: What Are the Pros and Cons?
Statins, Diabetes, and Blood Sugar Statins and Blood Sugar Almost all adults with diabetes between the ages of 40 and 75 are recommended to use a statin.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b9690116-0889-4c6e-8098-04ef8cf75d81 That’s because people with diabetes are twice as likely to develop heart disease or stroke, and statins help reduce that risk.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b1ffefb9-b975-4184-8c39-84f7efd646e4 It’s worth knowing that statins cause a small increase in blood glucose . That’s not enough to cause diabetes in someone with normal blood glucose, Miller says, but it may be possible for statin therapy to nudge a patient with prediabetes over the diabetic threshold sooner than they may have otherwise. Nevertheless, experts still agree that the heart health benefits outweigh downsides of mildly elevated blood sugar levels.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296e84b868-8542-4841-87b9-17e477d71015
Beyond LDL Beyond LDL Cholesterol While LDL cholesterol is the primary target of statin therapy, these medications have other benefits, too. Dr. Al-Kindi says that LDL doesn’t tell the whole story, and that doctors are increasingly using other assessments to gauge who might benefit from statin therapy. “Today is a great day to be a patient because we have newer tests available, such as coronary artery calcium scoring, apolipoprotein B, and lipoprotein(a), each serving distinct roles,” says Safwan Gaznabi, MD , a cardiologist at Linda Loma University Health in California. Here’s what those tests measure and when they’re ordered.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293b76e1a4-3c11-451f-9f01-2bd6f60f3da5 Coronary Artery Calcium (CAC) CAC is a heart scan that detects early plaque buildup in the arteries, which can show if heart disease has already developed, Al-Kindi says.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cdb2c17d-833c-4891-b860-f23ffb286bf4 A high CAC result puts a patient in the same risk category as someone with established heart disease, Miller says, and can prompt intensified statin therapy. Apolipoprotein B (ApoB) ApoB is a particularly harmful protein found on the surface of several cholesterol-carrying particles.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d16118f0-ebd2-4e51-ba95-dc8e5cf21a5f An ApoB test can offer a more detailed picture of heart health risks, and a high measurement may call for starting or intensifying statin use. Lipoprotein(a) Lipoprotein(a), or Lp(a), is “much more artery-clogging than LDL,” says Dr. Miller, but your levels are genetically determined and remain stable over time. While statins do not lower Lp(a), they can help mitigate the risk caused by naturally high Lp(a) levels.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc3a1b2b-f8b5-482c-8c9c-d76ea8d0fcb2