Tips for Clinicians on When to Discuss Statin Therapy
A new report published in the Journal of the American College of Cardiology provides clinicians with a guideline to help their patients decide on whether or not to initiate statin therapy.
For patients with high cholesterol but no overt heart disease, the guidelines recommend "considering" preventive therapy in patients whose 10-year risk score for suffering a heart attack or stroke is ≥7.5% with room for some variation. Some of the tips to guide "the statin" conversation with patients include the following:
- 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 guideline also emphasizes the five M's of statin side effects that should be discussed with patients: memory, metabolism, muscle, medication interaction and major organ effects. With statins and diabetes, it is important to explain to patients that cholesterol-lowering drugs tend to unmask underlying diabetes and hasten its onset in those predisposed to it. For statins and memory, reassure patients that there is very little evidence – most of it unconvincing – that statins impair memory function. As well, assure patients that severe muscle damage from statin use is exceedingly rare, but that minor aches and pains are common yet often benign.
For more information visit JACC.org.