Here's when to take statins or not

A new study has offered clinicians tips to help patients make the right call whether to use cholesterol-lowering statins or not.

While the decision to use the drugs in patients with a history of heart attacks and strokes is mostly clear-cut, that choice can be a far trickier proposition for the tens of millions of Americans with high cholesterol but no overt disease.

Lead author Seth Martin of Johns Hopkins University said that given that heart disease tops mortality charts as the number one-killer of Americans, "to statin or not to statin" is one of the most important questions faced by patients and physicians alike, adding that their report offers concrete tips for physicians on how to conduct this vital discussion and to reduce patient uncertainty and frustration in making this complicated decision.

The ACC/AHA guidelines say doctors should use a complex equation to determine a patient's risk of heart disease. This calculation takes into account cholesterol levels and other aspects of the patient's health. The final number gives the doctor a risk number for that patient. This number is used to determine whether statin therapy should be recommended.

Author Neil J. Stone noted that that decision should be informed by the intersection of scientific evidence, clinical judgment and patient preference, but clinicians need to individualize the advice.

It's a simple concept: making sure they're not treating the disease but the person with the disease, and, in this case, those at elevated risk for it, said Martin. Done the right way, this is precision medicine at its best.

Tips for clinicians on having the statin conversation:

Don't get fixated on a number. Ask patients to use the risk-score calculator prior to their visit and come armed with questions.

Shared decision-making doesn't mean split decision-making.

When there's no time, make the time.

Contextualize risk. One way to provide meaningful perspective is to compare a patient's likelihood of suffering a heart attack or stroke to someone of the same age, gender and race, who has optimal risk factors.

Aim for the highest tolerable dose, unless the patient is predisposed to side effects or taking interacting medications.

Pay attention to news media. Periodically scan major news headlines about statins and heart disease.

The study is published in the Journal of the American College of Cardiology.