In 2013 the American Heart Association and the American College of Cardiology published a joint statement for the treatment of hyperlipidemia (high cholesterol) in adults. This somewhat controversial statement established guidelines for treatment with statins in various patient populations. The statin drugs include Lipitor (Atorvastatin), Zocor (Simvastatin), Crestor, Pravastatin and Lovastatin. I will try to summarize the most important points in this position paper. First off there is no question that statins have an important role in the treatment of hyperlipidemia for secondary prevention in patients with established heart disease; i e. patients with prior heart attack, stroke, bypass surgery, peripheral arterial disease or prior coronary stents. Multiple studies have shown a clear mortality benefit to lowering cholesterol in these patient populations. Statin therapy is recommended regardless of the cholesterol level. For patients less than 75 years of age an aggressive approach is recommended to lower LDL cholesterol over 50%. For older patients greater than 75 a moderate cholesterol lowering regimen is recommended to lower cholesterol between 30 to 50%. The recommendations for primary prevention are somewhat more controversial as there is a concern about side effects from taking statins in patients without established cardiovascular disease. The recent guidelines recommend treatment for diabetics or patients with LDL cholesterol greater than 190 if they are between 40 and 75 years of age. For non diabetics and people with LDL cholesterol between 70 and 189 treatment is recommended if the 10 year risk of cardiovascular disease is greater than 7.5%. One can check their risk by going to http://my.americanheart.org/cvriskcalculator. In summary patients with established cardiovascular disease should be on statins regardless of their cholesterol levels. People with diabetes and LDL cholesterol greater than 190 should be treated if they are over 40. People who have a 10 year risk of developing cardiovascular disease that is greater than 7.5% should consider ultram treatment as well. In all cases diet and exercise should be part of the treatment regimen. If you have any additional questions feel free to schedule an appointment to discuss this further.
Barry E. Shapiro, D.O., F.A.C.C., F.A.C.O.I.
Clinical Assistant Professor of Medicine, Rowan University School of Osteopathic Medicine