America's Heart Problem
The American Heart Association and the American College of Cardiology have generated a lively discussion with the release last week of guidelines for prescribing statins, medications to lower blood cholesterol to help prevent heart attacks and strokes. If little else, the controversy focuses attention on how best to address the country's leading cause of death.
Heart attacks and strokes take a grim toll. The Centers for Disease Control and Prevention reports that 715,000 heart attacks occur in the country each year. Deaths from heart disease total about 600,000 a year. Each year, nearly 800,000 Americans suffer a stroke, and almost 130,000 die as a result. Clearly, avoiding heart attacks and strokes is a high public health priority.
The New Guidelines: Controversies
The new guidelines depart significantly -- and positively for the most part -- from those doctors commonly use to treat individuals at risk of heart disease. Doctors currently prescribe statins (sold under brand names such as Lipitor, Crestol and Zocor) based on whether a patient's LDL or "bad" cholesterol is above a certain number.
The new recommendation includes in the decision other risk factors, among them blood pressure, diabetes, smoking habits and age. A broader basis for medication is sensible as strokes and heart attacks are not caused solely by high levels of LDL. The guidelines also recommend statins for anyone who has a 7.5 percent chance of having a heart attack or stroke in the next 10 years.
As critics note, the recommendations would double the number of adults reliant on medication to prevent or control cardiovascular disease. Critics got a boost when a risk calculator accompanying the guidelines was shown to be inaccurate in determining who should be put on statins.
Without question statins are effective and save lives. Still, for good reason, critics counsel caution. They point to the risk of exposing millions of people to potent drugs (probably for life) with little evidence the drugs would be beneficial to healthy people with a 7.5 percent chance of developing heart disease. Important, too, is concern about the emphasis on medications over lifestyle, particularly exercise and dietary changes, to maintain reasonable good health or to control chronic conditions. ___
(c)2013 the Akron Beacon Journal (Akron, Ohio)
Visit the Akron Beacon Journal (Akron, Ohio) at www.ohio.com
Distributed by MCT Information Services