The question of statins

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Illustration: C R Sasikumar Illustration: C R Sasikumar
SummaryRecent American guidelines recommend statins to prevent heart attacks without monitoring lipid levels. However, doctors have urged caution due to the many side effects of these drugs.

is something that will make them better, you can count on that we’ll do it.” Dr Smith is a former president of the AHA and the executive chairman of the guidelines committee.

The guidelines are based on evidence gathered from medical research published between 1990 and 2012 and one criticism that has emerged is that more recent studies should have been incorporated before arriving at such sweeping recommendations.

With no Indian guidelines in cardiovascular diseases, doctors here have been following a combination of American, European and Canadian guidelines. Most Indian doctors say they will wait for implementation of the guidelines in the West.

AIIMS cardiology HoD Dr V K Bahl said, “Till now, doctors were advised to continue giving statins while monitoring levels of LDL. The drugs were only prescribed for people with high LDL. The new guidelines are essentially telling clinicians to give statins in moderate to high intensity and not constantly check cholesterol levels.”

Dr Bahl said the guidelines have advised against prescription of additional non-statin category drugs that are often given as “added measures” to “improve outcomes of statins”. “If LDL levels don’t go down despite giving statins, doctors prescribe other categories of drugs such as fenofibrates. These drugs often increase the side effects associated with statins, and the guidelines have said these additional drugs have no role in controlling cardiac episodes,” Dr Bahl said.

The authors note in the guidelines, “Non-statin therapies... do not provide acceptable ASCVD risk reduction benefits compared to their potential for adverse effects in the routine prevention of ASCVD.”

The guidelines have identified four groups, as “statin benefit groups” — those with a history of cardiac episodes; those with “primary elevations” of LDL cholesterol with no other indications of cardiovascular disease; those between 40 and 75 years old diagnosed with diabetes and with moderate to high levels of LDL not necessarily with symptoms of cardiovascular diseases; and those between 40 and 75 years old without symptoms of cardiac diseases or diabetes, but with a 7.5 per cent or higher risk of contracting cardiovascular problems within an estimated 10-year period.

Doctors said these four statin benefit groups could lead to a manifold increase in the potential users of these drugs. “Asymptomatic people with moderate cholesterol levels but with a potentially high risk of contracting the diseases have been advised to be put on statins, which in effect increases the (number of) patients. We are talking thousands and thousands

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