Seniors 60-Plus Most Affected by New Expanded
Guidelines for Statin Use
Almost 13 million more Americans to be eligible for
statins; 8.3 million would be people over the age of 60, says Duke
March 20, 2014 An additional 12.8 million in U.S.
may soon be taking statins to prevent cardiovascular disease, including
stroke, due to new guidelines expanding the criteria for use to include
people with an elevated 10-year risk. The most affected will be seniors
between the ages of 60 and 75 without cardiovascular disease - 87.4
percent of men and 53.6 percent of women will fall within the new
The increase is much more pronounced among adults
free of cardiovascular disease who are over age 60, with 77 percent
recommended for statin use under the new guidelines vs. 48 percent under
the previous standards. This contrasts with a modest increase from 27
percent to 30 percent among U.S. adults between the ages of 40 and 60.
Under the earlier guidelines, only about 30.4
percent of men between the ages of 60-75 were recommended for statin
use. This takes a gigantic jump to 87.4 percent. Similarly for healthy
women in this age group, those recommended for preventive statin use are
projected to rise from 21.2 percent to 53.6 percent.
The analysis of health data published online March
19, 2014, in the New England Journal of Medicine, for the first
time quantify the impact of the American Heart Association's new
guidelines (see story in sidebar), which were issued in November and generated both controversy
and speculation about who should be given a prescription for statins.
The elevated risk criteria will be based on a
The few data available did not clearly support
initiation of high-intensity statin therapy for secondary prevention in
individuals 75 and older
Nov. 13, 2013 The new clinical
practice guideline released yesterday for the use of statins in the
treatment of blood cholesterol in people at high risk for cardiovascular
diseases caused by atherosclerosis, or hardening and narrowing of the
arteries, that can lead to heart attack, stroke or death, identified
four major groups to target and at least two of them exclude seniors
over age 75. It does, however, support the continuation of
statins beyond 75 years of age in persons who are already taking and
tolerating these drugs.
"The biggest surprise of the research was the
age-dependent split for those affected by the new guidelines," said lead
author Michael J. Pencina, Ph.D., professor of biostatistics at Duke
Clinical Research Institute.
"We anticipated that the impact would be
age-dependent, but not to the degree observed. The changes for both men
and women in the older age groups where huge compared to those between
the ages of 40 and 60."
The DCRI-led research team determined that the new
guidelines could result in 49 percent of U.S. adults ages 40-75 being
recommended for statin therapy, an increase from 38 percent.
Overall, of the 12.8 million additional U.S. adults
recommended for statin use under the new guidelines, 10.4 million are
people who would be prescribed the drugs for preventive care. Of those
preventive users, 8.3 million would be people over the age of 60.
"We sought to do a principled, scientific study to
try to answer how the new guidelines might affect statin use,
particularly as they focused eligibility on patients with an increased
risk of developing cardiovascular disease," said Pencina.
"By our estimate, there might be an uptake in usage
as a result of the guidelines, from 43.2 million people to 56 million,
which is nearly half of the U.S. population between the ages of 40 and
Pencina and colleagues from McGill University and
Boston University used the National Health and Nutrition Examination
Surveys (NHANES) for their analysis, focusing on 3,773 participants
between the ages of 40-75 who had provided detailed medical information,
including fasting cholesterol levels from blood tests.
The analysis also projects that an estimated 1.6
million adults previously eligible for statins under the old guidelines
would no longer be candidates under the new standards. This group
included primarily younger adults with elevated cholesterol but low
10-year risk of cardiovascular disease.
Pencina said an important limitation of the study
is the necessary assumption that the new guidelines would be followed to
the letter; in real life, people may be recommended for statins but
decline to start the therapy.
"Recommendations are just that recommendations,"
Pencina said. "These guidelines correctly call for a thorough discussion
between the doctor and patient about the risks and benefits of statins.
It's not like everybody who meets the guidelines should all of a sudden
go on statins."
In addition to Pencina, study authors from Duke
include Ann Marie Navar-Boggan, Benjamin Neely and Eric D. Peterson;
with Ralph B. D'Agostino from Boston University; Ken Williams of KenAnCo
Biostatistics; and Allan D. Sniderman from McGill University.
The Duke Clinical Research Institute funded the
study, along with grants from M. Jean de Granprι and Louis & Sylvia
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