Statin Guidelines May Be Missing At-Risk Patients, Over-Targeting Others

According to a new study, the most recent guidelines on statin use in patients at risk of heart disease appear to exclude middle-aged adults, who could benefit from these cholesterol-lowering drugs, and overprescribe in the elderly. Results of the analysis are published in the Journal of the American College of Cardiology.

Researchers from the Duke Clinical Research Institute suggest small changes to the guideline can benefit more patients aged 40–55 years with premature heart disease and prevent unnecessary prescribing in adults >65 years. The recent statin guidelines issued by the American Heart Association/American College of Cardiology in 2013 recommend doctors to consider treatment in any patient whose 10-year risk is calculated at ≥7.5%.

However, when the 10-year risk calculation was applied to patients who participated in a leg of the Framingham Heart Study started in 1975 (n=3,685), researchers found that over half of patients aged 40–55 years who ended up with heart disease would not have been detected. The analysis also found that the statin guidelines would over-recommend its use in adults aged >60 years, a portion of whom did not end up developing heart disease within 10 years.

Setting the treatment threshold to ≥5% for patients aged 40–55 years, and 15% for elderly may help identify more middle-aged adults who develop heart disease early and reduce unnecessary medication for others, study authors suggest. Future guidelines can be improved by focusing on recommendations based on age and sex variations.

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