Statins are medicines that help lower the cholesterol levels in the blood. Given that heart disease tops the mortality charts, to use statins or not is one of the most important questions faced by patients and physicians alike. A new report by Johns Hopkins University offers concrete tips for physicians on how to conduct this vital discussion and to reduce patient uncertainty and frustration in making this complicated decision.
The American Heart Association guidelines recommend the use of a complex equation to determine a patient's risk of heart disease. This calculation takes into consideration cholesterol levels and other aspects of the patient's health. The final number gives the doctor a risk number for that patient, which is then used to determine whether statin therapy should be recommended.
Author Neil J. Stone said, "The decision should be informed by the intersection of scientific evidence, clinical judgment and patient preference, but clinicians need to individualize the advice. It's a simple concept- making sure they're not treating the disease but the person with the disease, and, in this case, those at elevated risk for it. Done the right way, this is precision medicine at its best."
1. Do not get fixated on a number, but ask patients to use the risk-score calculator prior to their visit and come armed with questions.
2. Shared decision-making does not mean split decision-making.
3. When there is no time, make the time.
4. Contextualize the risk of heart disease or stroke. One way to provide meaningful perspective is to compare a patient's likelihood of suffering a heart attack or stroke to someone of the same age, gender and race, who has optimal risk factors.
5. Aim for the highest tolerable dose of statins, unless the patient is predisposed to side effects or taking interacting medications.
6. Pay attention to news about statins and heart disease.
This study is published in the Journal of the American College of Cardiology.