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NPR 2018-12-04

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Before Starting A Statin, Talk It Over With Your Doctor


A study out today pushes back against the notion that up to 40 percent of healthy Americans should be taking statin drugs to reduce the risk of heart disease. The study argues that the guidelines have not adequately considered the risks from these drugs. NPR's Richard Harris reports.

RICHARD HARRIS, BYLINE: The risks from these drugs aren't great, but the benefits are also not that great for people who have never had heart disease. To prevent a single heart attack, something like 50 to 200 people need to take statins for five years. To assess the overall value, Milo Puhan, an epidemiologist at the University of Zurich, focused on the potential harms of these widely used drugs. He says those harms get short shrift in guidelines that doctors use to figure out who should be taking statins.

MILO PUHAN: Some harms are mentioned, but it's entirely unclear how they were considered when coming up with the recommendation. And in our approach, we very explicitly considered the harms.

HARRIS: The most common is muscle pain, which usually goes away if a patient stops taking the drugs. People taking these drugs are also at higher risk of diabetes, which is harder to reverse. Puhan also found that some statins were more effective than others, with atorvastatin being the best of the bunch.

PUHAN: Although the benefit-harm profile is known to be better for some than for other statins, this is not really reflected much in the guidelines.

HARRIS: His report in The Annals of Internal Medicine also finds that benefits fade compared with harms as people get older.

PUHAN: One size doesn't fit it all. I think that's a very important message and that the elderly do not benefit as much as previous studies might have thought.

HARRIS: Based on his assessment, Puhan says perhaps 15 to 20 percent of older adults should be taking statins, far less than the 30 or 40 percent suggested by current medical guidelines. Ilana Richman, an internist at the Yale University School of Medicine, co-wrote an editorial about the paper and came away from it thinking that doctors need to spend more time talking about the pluses and minuses of statin treatment, personalizing the recommendations more than they do now.

ILANA RICHMAN: I think for me as a physician, this kind of data suggests that if we give more weight to the potential for adverse events, then, yeah, maybe it's reasonable to hold off for lower-risk patients.

HARRIS: Do physicians actually have time to have these conversations with their patients?

RICHMAN: That's a real challenge. I will absolutely agree that it's challenging and time-consuming, and it involves explaining sophisticated concepts in a short period of time.

HARRIS: Yet that is increasingly the expectation. Just two weeks ago, the American Heart Association issued new guidelines calling for more nuanced conversations around who would benefit from statins. Scott Grundy, who chaired the guideline committee, says the new recommendations suggest people in the moderate-risk gray area should get a heart CT scan called a calcium scan.

SCOTT GRUNDY: If you have no coronary calcium, then your chance of having a heart attack over the next 10 years are very low.

HARRIS: And it turns out many people who look like they might need statins actually don't when you look at the calcium in their heart arteries.

GRUNDY: That means a lot of people are going to be treated unnecessarily if they don't have the calcium scan.

HARRIS: But Grundy says that test is only a sensible screening tool for people who are healthy.

GRUNDY: And if you have had a heart attack or stroke, it's almost mandatory to be on a statin drug.

HARRIS: Grundy, at the University of Texas Southwestern Medical Center, disagrees with a lot of the particulars of the Swiss study, but both reports come to the same broad conclusion - doctors and patients should spend more time reviewing each person's needs when it comes to a statin prescription that could be taken for life. Richard Harris, NPR News.


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