All About Statins

There are so many medical terms to understand surrounding managing cholesterol, now let’s add statins.

Statins are a class of drugs commonly prescribed by cardiologists to lower cholesterol in the blood.  Taken once a day, statins inhibit an enzyme in the liver called HMG-CoA reductase, which reduces the production of cholesterol in the liver, hence cholesterol levels in the blood.

The revised 2018 Cholesterol Guidelines by the American College of Cardiology impacted the prescription of statins. Focusing on saving lives, a broader risk assessment, and a cardiologist’s skilled judgement is determining statin prescription today. “Statins are remarkable drugs, which have had an unbelievable impact on human health over the last few decades. They are much more than just drugs that lower cholesterol numbers. Statins also stabilize disruptive inflammation and plaque throughout the body, reducing the risk for heart attacks and stroke,” USF Health Cardiologist Dr. Bibhu Mohanty said.

ASCVD Risk Score

Statins are regularly prescribed by cardiologists based on an ASCVD risk score. The development of the ASCVD (Atherosclerotic Cardiovascular Disease) Risk Score was explained in depth in the blog, Cholesterol Confusion.

The ASCVD Risk Score determines four levels of risk: High Risk, Intermediate Risk, Borderline Risk, and Low Risk, for patients between the ages of 40 and 79.  The calculator is just a tool, but it is important that it be considered as part of the patient’s overall health.

There are three main treatment regimens for statins based on risk level:

  • High intensity, which typically lowers LDL-C by 50% or more
  • Moderate intensity, which lowers LDL-C by 30% to 49%
  • Low intensity, which lowers LDL-C by 30% or less

Prescribing Statins

Summarized below are important points from the American College of Cardiology’s revised 2018 Cholesterol Guidelines in reference to the prescription of statins.

  • Risk determines statin prescriptions. The use of a statin to lower cholesterol levels is now primarily guided by the patient’s risk, not just a cholesterol number. Compelling research has shown if treating a cholesterol number does not lower a patient’s risk of a heart attack or stroke, the drug prescribed hasn’t been effective.
  • Statin prescription is necessary due to high cholesterol levels. If you have high cholesterol, lifestyle changes and statin therapy is recommended regardless of risk level. There are exceptions to the overall approach.
  • Statin prescription is necessary due to prior heart attacks and strokes.  For patients who have had a heart attack or stroke already, whatever their LDL cholesterol level is, the occurrence of an event tells us that it was not low enough; and the patient would benefit from further reducing it. It is recommended that these patients be on high intensity statin therapy. The logic of this approach is that the cholesterol number is not important, it’s about saving lives.
  • Statins prevent further heart attacks and strokes. Statin medications were once just used to lower bad cholesterol numbers, but along the way, we noticed that patients who were on statins had fewer heart attacks and strokes – independent of their LDL level. This is a very important finding.

“Once a patient has a heart attack or stroke, they are instantly in a high-risk group of having additional events or death – irrespective of their cholesterol number, even if they had a relatively low LDL cholesterol,“ Dr. Mohanty said. “We know that those patients who are on statins have a lower risk of repeat heart attack or stroke than those who are not. As our guidelines have evolved, this notion of reducing risk, not the LDL number, has been extended to primary prevention in patients who have not yet had events.

“Patients should know that statins are generally very safe and effective at saving lives with one notable side effect being muscle aches, which occur in about 1 in 50 patients. The good news is, if one statin causes myopathy, the patient will very likely be able to tolerate another drug or another dosing level,” Dr. Mohanty said.

To find out more about changes in the 2018 Cholesterol Guidelines, read Cholesterol Confusion and Kids and High Cholesterol.

We are excited to share our Cardiology department is expanding!  Dr. Jennifer Bennett, Dr. Patrick Chang, and Dr. Rachel Harris are accepting new patients. Learn more about cholesterol and get to know Dr. Jennifer Bennett and Dr. Patrick Chang from USF Health Minute.

To make an appointment with USF Health Cardiology, call (813) 259-0600.

Written By: Kathleen Rogers


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