New research from Harvard’s School of Public Health is floating the idea it would be cost effective to treat up to 67 percent of all adults aged 40 to 75 with statins, a cholesterol-fighting drug. Did I miss a pharmaceutical company missing its quarterly estimates?
Why would doctors treat that many adults with a statin? Effectively, it would be used as a heart attack preventive. Study authors wrote that expanding the guidelines to include more people would prevent 161,560 cardiovascular events. The events include heart attacks and strokes over the lifetime of the adult.
Statin guidelines were already expanded in 2013 by the American Heart Association and the American College of Cardiology. Controversial at the time, it opened the door to treating 26 percent of all American adults over the age of 40.
Researchers, led by Ankur Pandya, assistant professor of health decision science at Harvard’s School of Public Health, looked for the sweet spot of maximum health benefits and cost. The cost benefit analysis included both drug prices and side effects a large group of people would be willing to accept.
Published in JAMA, the optimum range of American adults in the age range was between 48 and 67 percent. It’s like Oprah, but for medicine. You get a pill. He gets a pill. She gets one. To hell with it, everyone gets a pill….
The number does seem high, especially when you start talking two-thirds of all adults, but the Harvard study correctly points to heart disease as the country’s number one killer. Statins have shown their effectiveness, safety and present a low-cost way to combat heart disease.
Statin Use and Risk Threshold
In 2013, the heart disease guidelines for the use of statins shifted away from LDL cholesterol target levels to a risk calculator of the patient’s 10-year risk of heart disease or stroke. An example patient would be a 40-year-old without cardiovascular disease, or diabetes could score a 7.5 on the calculator.
Under the new guidelines, the patient would be a candidate to be placed on statins. The pushback from critics has been intense. A common refrain from opponents is the calculator overestimates risks, and patients end up on statins who never need the drugs in the first place.
The Harvard study wants to push the calculator score to 3. Below that, the costs outweigh the health benefits. That’s comforting.
Even with the headlines of using statins as a heart attack preventive, drug treatments are still individualized. No one is going to take a broad risk analysis and apply it to your specific situation. While statins are safe, starting a prescription drug is still a decision that has to be weighed by you and your doctor.
Want a few methods of heart disease prevention that do not involve prescription drugs? If you smoke, start working your way to ex-smoker. Eating healthy, exercising and good lifestyle choices are all excellent preventives.
You’ll never hear a doctor suggest drugs over a simple changes to your everyday life. Put down the junk food, dust off the home gym and get after it. No more ‘tomorrows.’ Start today.