New Cholesterol Guidelines: An Annapolis Primary Care Spotlight
An important JAMA article published Tuesday supports the AHA/ACC 2013 guidelines which dramatically shifted the target from “LDL” to “Risk”, as to who should be on a statin (such as Lipitor or Zocor). Specifically, the new guidelines urge patients to consider statins if they have an overall risk of 7.5 percent of developing a heart attack or stroke in the next 10 years using this online tool. The tool looks at factors as gender, age, race, total cholesterol, systolic blood pressure and smoking
A study published last year estimated that 56 million American adults, or almost half those age 40 to 75 should be on a statin. Currently only 25% are on these medications. In fact, the new guidelines would put 8-12 million more Americans on statin drugs.
In a piece published on NPR today, Harlan Krumholz, a Cardiologist at Yale University School of Medicine said, “One of the new studies endorses the idea that treating based on cardiovascular disease risk is better than treating based on some target level.“
In a nice FAQ piece in the Washington Post today, they summarize the new JAMA article as follows: “The idea (is) that the new guidelines may do a better job of figuring out who needs statins and who doesn’t.” So, if you haven’t seen your doctor in a while, now is the time to get back in there for a check up!
It is also important to note that this study was funded by the National Institute of Health and was not funded by “industry” or “big Pharma” suggesting that these results were not influenced by financial considerations.
In fact, the 2nd study published this week examined the finances and longevity benefits and found “If two-thirds of all American adults were on the drugs we would see 125,000 to 160,000 fewer heart attacks or strokes each decade.
Are these medications expensive?
Some statins can be obtained for as little as $4 per month or $10 for 90 day supply, such as Mevacor. Prices for Lipitor in
Annapolis are $10 at Sam’s Club (where you don’t need a membership to use the pharmacy) and Walmart using a free coupon available through Evolve Medical’s App (download here on Apple App store or Google Play). But buyer beware, the price is $154 at Walgreens and $152 at Rite Aid.
In the 2nd study, researchers from Harvard’s T.H. Chan School of Public Health calculated that every quality-adjusted life-year (QALY) gained cost $37,000. That number, they said, was “acceptable.” Even more lenient thresholds of 4 percent risk of an event in the next 10 years would cost an additional $100,000 QALY and 3 percent $150,000 QALY.
So what is the take away message (for me)?
If you’re already on statins and your physician used the 2013 guidelines, the information from the new studies suggests you should stay the course if the side effects are tolerable. If you aren’t on a statin and haven’t seen a doctor since before 2013, you may want to check in to see whether you could benefit.