New guidelines on statin therapy

New guidelines on the treatment of cholesterol highlight four groups of people who will most likely benefit from statin therapy, and emphasize the need to tailor stain therapy to meet the individualized needs of each patient.

In her presentation at the ACC meeting entitled “Dyslipidemia: What is the Treatment and Who Needs It?,” Donna M. Polk, MD, MPH, Brigham and Women’s Hospital, Boston, MA  walked participants through the new guidelines and how they should be used in clinical practice.

In the 2013 ACC/AHA Guideline on Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults Hypertension, patients most likely to benefit from statin therapy include those with clinical arteriosclerotic cardiovascular disease (ASCVD), low-density lipoprotein cholesterol (LDL-C) >190 mg/dL in adults 21 years of age or older, diabetes in people aged 40-75 years and LDL-C 70-189 mg/dL, and persons without diabetes aged 40-75 years with LDL-C 70-189 mg/dL and estimated 10-year ASCVD risk of 7.5% or greater.

For people not in one of these groups most likely to benefit from statins, the guidelines emphasize the need for health care practitioners to discuss with each patient the individual risk and potential role for statin therapy.

“Several factors inform this discussion,” Dr. Polk said. “Including but not limited to family history of premature coronary disease, markers of inflammation, and evidence of significant subclinical atherosclerosis as assessed by coronary calcium scores.”

The guidelines also emphasize the role for nonstatin therapy. According to Dr. Polk, the addition of nonstatin cholesterol-lowering drugs should be considered in patients who experience a persistent less-than-anticipated therapeutic response to a statin drug. Addition of a nonstatin cholesterol lowering drug can also be considered in patients with ASCVD but only if ASCVD risk-reduction benefits outweigh the potential adverse effects in people with high risk factors (ie, clinical ASCVD <75 years of age, baseline LDL-C >190 mg/dL, and diabetes in people 40-75 years of age.

Overall, the guidelines emphasized starting with lifestyle factors to treat elevated cholesterol and including statins as needed.

“Treating elevated cholesterol and elevated risk should always start with emphasis on lifestyle,” she noted. “When statins are added, their effectiveness should be evaluated, long-term compliance reassessed, and modifications in doses be made for those that are at high risk for side effects from high dose statins.”