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Health

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Half of US adults 40 to 75 judged eligible for statins

Almost half of Americans ages 40 to 75 and nearly all men older than 60 qualify to consider cholesterol-lowering statin drugs under new heart disease prevention guidelines, an analysis finds.

It’s the first independent look at the effect of the guidelines issued in November and shows how dramatically they shift more people toward treatment. Supporters say they reveal the true scope of heart risks in America. Critics have said the guidelines overreach by suggesting medications such as Zocor and Lipitor for such a broad swath of the population.

“We wanted to be really objective and just quantify what the guidelines do, and not get into a discussion about whether they are correct,” said Michael Pencina, the Duke University biostatistician who led the analysis. It was published online Wednesday by the New England Journal of Medicine.

Under the new guidelines, 56 million Americans ages 40 to 75 are eligible to consider a statin; 43 million were under the old advice. Both numbers include 25 million people taking statins now.

“That is striking … eye-opening,” Dr. Daniel Rader of the University of Pennsylvania said of the new estimate.

But because too few people use statins now, the advice “has the potential to do much more good than harm,” said Rader, a cardiologist who had no role in writing the guidelines.

Nearly 500,000 additional heart attacks and strokes could be prevented over 10 years if statin use was expanded as the guidelines recommend, the study estimates.

The guidelines, developed by the American Heart Association and American College of Cardiology at the request of the federal government, were a big change.

They give a new formula for estimating risk that includes blood pressure, smoking status and many factors besides the level of LDL or “bad” cholesterol, the main focus in the past.

For the first time, the guidelines are personalized for men and women and blacks and whites, and they take aim at strokes, not just heart attacks. Partly because of that, they set a lower threshold for using statins to reduce risk.

The guidelines say statins do the most good for people who already have heart disease, those with high LDL of 190 or more, and people older than 40 with Type 2 diabetes.

They also recommend considering statins for anyone 40 to 75 who has an estimated 10-year risk of heart disease of 7.5 percent or higher, based on the new formula. This means that for every 100 people with a similar risk profile, seven or eight would have a heart attack or stroke within 10 years.

Under this more nuanced approach, many people who previously would not have qualified for a statin based on LDL alone now would, while others with a somewhat high LDL but no other heart risk factors would not.

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