Two conflicting sets of medical guidelines may cause a reduction in statin use in the United States, a new study revealed.
According to researchers, following medical guidelines from the U.S. Preventive Services Task Force (USPSTF) over guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA) may lead to fewer number of statin users.
In fact, more than 9 million people in the United States may miss out on statins, a drug that can lower cholesterol levels and prevent heart attacks, should doctors choose to follow the 2016 USPSTF statin therapy guideline.
Conflicting Medical Guidelines
The guideline from the ACC/AHA suggests that people aged 40 to 75 years who face a 7.5 percent risk of having a heart attack in the next decade should take statins. These cholesterol-lowering drugs should also be taken by people with cardiovascular disease, people with diabetes who are between 40 to 75 years old, and adults with high levels of bad cholesterol, the guideline said.
On the other hand, the USPSTF guideline recommends statins to people in the same age range who face at least 10 percent risk of having a heart attack or stroke in the next 10 years and at least one heart disease risk factor such as high blood pressure or diabetes.
Preventing Strokes And Heart Attacks
Under the "more conservative" USPSTF guideline, fewer people would be able to take statins, said Michael Pencina, the study's lead author. With that in mind, he and his colleagues tried to quantify the impact of these conflicting guidelines and present them in numbers.
Pencina and his team applied the USPSTF recommendation to national data collected from 3,416 people who did not have history of heart disease in 2009 to 2014. They discovered that 21.5 percent of these respondents were already taking statins to prevent heart attacks or strokes.
If all doctors followed the 2013 ACC/AHA guideline, an additional 24.3 percent of respondents would be taking statins. If all doctors followed the 2016 USPSTF guideline, however, the number drops to 15.8 percent of respondents. Researchers say the difference is equivalent to about 9.3 million people.
Under the USPSTF guideline, Pencina said some people with diabetes would be excluded in taking statins. More than half of them are middle-aged adults who face a 30 percent average risk of experiencing a cardiovascular event in the next 30 years.
In a statement, the USPSTF said its guideline relies on the "best available evidence" on cardiovascular event prevention. The task force reviewed its guideline based on 19 trials that involved more than 71,000 people without history of heart disease.
Ultimately, the USPSTF said the decision whether statin should be taken or not must be between the doctor and the patient.
Meanwhile, Pencina stressed the importance of being informed about the risk of cardiovascular disease, as well as the risks and benefits of statin.
"Both sets of guidelines ... recommend an informed decision between the patient and the clinician," added Pencina.
Details of the new study are published in the journal JAMA.