Are you among the more than 70 million American adults who should be discussing the possibility of statin therapy with a physician to reduce your risk of
The calculator considers factors such as age, gender, race, total cholesterol levels and triglycerides, high-density lipoprotein levels (HDL cholesterol, which at high levels is protective against heart disease), whether you have
Under the new clinical practice guidelines issued Tuesday by the American College of Cardiology and the
"You can't guess at this," says
Three groups of patients should not bother with the calculator, and instead run--not walk--to pick up their statin prescriptions. Those are: Patients who have already suffered
Generally, the new recommendations suggest that heart attack and stroke survivors and people with familial
We know that ethnicity as well as age and gender confers different heart and attack and stroke risks. And though the calculator factors in gender and age, it offers only two choices for race: White and African American. The authors of the new guidelines said that as more targeted research provides details, they hope to add in the risk of heart attack and stroke specific to Asian and Latino patients. Until then, they recommend that patients identify themselves by gender and age and leave ethnicity blank.
Other measures, too, may one day find their way into the risk calculators. These are readings that many physicians already know and take for patients. They include factors that are easy to recognize: a family history of premature heart disease in a first-degree relative; and an ankle brachial index, essentially a systolic blood pressure reading done at the ankle. Others are more complex: coronary calcium scoring, derived from radiological scans of the arteries feeding blood to the heart to look for signs of deposited calcium; and a C-reactive protein test, a key indicator of systemic inflammation.
Right now, these suspected "biomarkers" for risk are blinking yellow lights: Certain readings appear to indicate a patient is more likely to suffer a stroke or heart attack because of clogged arteries, but the research evidence is inconsistent or incomplete. If a physician has ordered such tests and sees worrisome measures--or if a family history of early heart attack or stroke is clear--those might tip the balance in favor of statin therapy.
For those who are not swept into a statin regimen by the new guidelines, don't get smug: For the 36% of American adults who are obese and otherwise healthy, for instance, there's no call for complacency. A study published this week in the journal JAMA