Task force's updated guidelines don't recommend daily aspirin for most adults to boost heart health

Latest statin guidelines maintain more conservative approach to preventing first stroke or heart attack

The recommendations are a bit more conservative than the guidelines put forth by the American College of Cardiology and the American Heart Association, and some doctors wonder if they should be more aggressive.

Specifically, USPSTF guidelines published Tuesday in JAMA recommend statin use in adults aged 40 to 75 who have one or more risk factors for cardiovascular disease and 10 percent in the next 10 years or higher risk of heart attack or stroke. These risk factors include diabetes, high blood pressure, smoking or high cholesterol. To calculate a person’s risk score, doctors also consider factors such as a person’s age, gender, ethnicity, blood pressure, cholesterol levels, and family history.

For people with a slightly less than 7.5% to 10% risk of heart attack or stroke over the next 10 years, the latest guidelines recommend talking with their doctor before deciding whether they should take a statin.

Since this group had a slightly lower risk, the benefits were smaller, even though they were still valid. In this case, patients should speak with their doctor to determine if they need to take one based on individual factors. “At the individual level, healthcare professionals and patients can work together to decide what is best for the patient, as there are other ways to reduce the risk of a stroke or first heart attack,” said a member of the task force. John Wong, professor of medicine at Tufts University PhD. This includes things like diet and exercise.

There are insufficient studies to recommend first-time statin use in adults 76 years and older.

The last time the USPSTF revised statin guidelines was in 2016. Since then, several new studies have established the effectiveness of statins, Wong said.

Most importantly, Wang said, 40 years of science have shown that statins are safe and a good primary prevention measure that reduces a person’s risk of developing or dying from heart disease.

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To make these recommendations, the USPSTF reviewed 26 studies comparing outcomes in people who took statins and those who didn’t. These studies involved more than 500,000 patients.

“Statins were significantly associated with a reduced risk of all-cause mortality,” the study said. This is true of all demographics.

Based on these studies, the risks of taking statins appear to be small. Concerns have been raised in the past that statins may increase a person’s risk of developing muscle problems or diabetes, but in general, these latest studies, which were used to develop these guidelines, did not include one study involving high-intensity statin therapy Both problems have increased, Show Real experts say.

Other guideline recommendations

An editorial accompanying the JAMA recommendation suggested that the guidelines should be more aggressive and more in line with the cholesterol guidelines recommended by the American College of Cardiology and the American Heart Association. These guidelines recommend statins for adults ages 40 to 75 who have a 7.5 percent or higher risk of heart attack or stroke over the next 10 years, not a 10 percent risk. The ACC/AHA guidelines also recommend statins for people with diabetes without calculating a person’s 10-year risk score, and recommend statins for those with extremely high cholesterol levels.
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“Individuals with higher baseline risk have greater absolute benefit from the intervention compared to the low-risk population. If statins are risky or expensive, then this tailored treatment strategy is justified. However, statins Class drugs are now available as generics that are both safe and affordable,” doctors at the University of Texas Southwestern Medical Center in Dallas wrote in an editorial.

ACC President Dr. Edward Fry said it’s important to remember that USPSTF guidelines are statements that apply to a broad patient group or population, whereas ACC/AHA guidelines are more aimed at individuals. Neither would make statins an automatic patient decision.

“Any medical decision needs to be made on an individual basis, and these guidelines give a kind of roadmap. There may be a few different routes to get where you want to go, but it’s a roadmap,” Frye said. “The differences between the guidelines are relatively small.”

For example, one area not covered in the USPSTF guidelines is a person’s coronary artery calcium score. A heart scan can look for calcium in the coronary arteries. There is a relationship between calcium and plaque. For patients at high or intermediate risk, this score can be used as another determinant.

Other factors considered by the ACC/AHA guidelines that are not part of the USPSTF calculus are what doctors call “risk-enhancing factors” that can also help make decisions about those borderline cases. For example, the guidelines exclude 35-year-olds with a family history of heart disease and high cholesterol but may be good candidates for statins, according to Dr. Salim Virani, a professor of medicine in the United States. Department of Cardiovascular Research, Baylor College of Medicine.

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“Risk enhancers may increase a patient’s short-term, 10-year risk, or in some cases, their lifetime risk of cardiovascular events, then these guidelines suggest that clinicians should err on the side of Recommendations of the Service Task Force,” Villani said. “But I do want to stress that even if clinicians take the recommendations of the more conservative U.S. Preventive Services Task Force and follow them very, very aggressively, we’re definitely going to see population-level effects with statin therapy. It’s really been studied For a long time now we know it works.”

Dr. Ian Neeland, a cardiologist at the Heart and Vascular Institute at Harrington University Hospitals and director of the UH Center for Cardiovascular Prevention, who was not involved in any of the guidelines, said another big takeaway from the USPSTF was to “reaffirm” their previous guidelines, and the science they use makes it clear that statins are safe.

“Overall, the serious risk of serious adverse events is very low, so the risk-benefit generally favors statin use in at-risk individuals,” Nyland said.

“Statins are very helpful in reducing long-term risk with very few side effects and great benefits. It’s one of the key drugs that’s changing the face of medicine,” Nyland added.

He also said it’s important to remember that guidelines are just guidelines. “They need to be used in clinical settings as well as in the art and science of medicine,” Nyland said.

Villani said more must be done to prevent heart problems.

“We’re definitely facing a big wave of cardiovascular disease in our country, and we really need to treat it with lifestyle therapy and medication,” Villani said.

what patients can do

It’s important for patients to ask their provider what their risk of a heart attack or stroke is over a 10-year period, Virani said. This is a calculation that requires expert knowledge and cannot be done on your own.

“Having this conversation doesn’t mean you need therapy, but it sparks a lot of important discussions, even about your lifestyle,” Villani said.

Of course, statins aren’t the only way to help people prevent a heart attack or stroke.

Both the USPSTF and the ACC/AHA recommend that patients quit smoking, engage in physical activity, and maintain a healthy diet to reduce risk.

“Statins are part of the prevention wheel. They’re not the only part,” Nyland said. “There’s diet, physical activity, maintaining a healthy weight, controlling blood pressure, ensuring diabetes or diabetes risk is controlled. All of these aspects have an impact on heart health. Statins are one way to reduce risk.”

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