Medical Research: What is the background for this study? What are the main findings?
Dr. Miedema: ” Released in November 2013, the ACC/AHA guidelines for the treatment of blood cholesterol attempt to target individuals that are most likely to benefit from cholesterol-lowering statin therapy. These guidelines are a significant change from prior guidelines that relied heavily on levels of bad cholesterol to determine who to treat. Instead, the new guidelines recommend focusing statin therapy on the individuals that are at the highest risk for heart attack and stroke, even if their cholesterol levels are within normal limits. In addition to recommending statin therapy for individuals with known cardiovascular disease, diabetes, or markedly elevated cholesterol levels, they also recommend statin therapy for individuals without these conditions but with an elevated estimated risk of a heart attack or stroke in the next 10-year based on a risk calculator that factors in an individual’s age, gender, race, and risk factors. Patients with an estimated 10-year risk > 7.5% are recommended to consider statin therapy. While I believe the scientific evidence supports this “risk-based” approach, one potential concern is that the risk-calculator relies heavily on age to determine an individual’s risk, so we wanted to examine the implications for these guidelines in an older sample of adults.”
Medical Research: What should clinicians and patients take away from this report?
Dr. Miedema: ” We studied 6,088 black and white adults age 66 to 90 in the Atherosclerosis Risk in Communities (ARIC) Study, a longitudinal study of cardiovascular disease sponsored by the National Heart, Lung, and Blood Institute that has been following participants for ~25 years. The ARIC cohort was reassessed in 2013 and the study analyzed the volume of statin-eligible participants based on the previous Adult Treatment Panel (ATP) III cholesterol guidelines compared to the newer ACC/AHA guidelines. Based on the prior ATP III guidelines, we found that just over 70% of the ARIC participants were eligible for statin therapy. In contrast, 97 percent were statin eligible by ACC/AHA criteria. For men 66-75 years old, the qualification rate was 100 percent. While half of the cohort was older than age 75, the ACC/AHA guidelines do not provide a recommendation for or against statin therapy. We don’t have great data on the efficacy of statin medications in the elderly so the guidelines drew a cut-off for the recommendations at age 75. This is understandable but it kind of leaves clinicians in the dark as to what to do with healthy elderly patients, who are often at high risk for heart attacks and strokes.”
Medical Research: What future research do you recommend as a result of this study:
Dr. Miedema: “We clearly need more research looking at the best way to determine who should and should not take a statin as well as the risks and benefits of statin therapy in elderly patients.