1 of 2 | Dr. Charles Hennekens, a medical school professor and heart disease researcher at Florida Atlantic University in Boca Raton, Fla., says too many patients at high risk of heart attacks and stroke are being “underdosed” with beneficial statin drugs. Photo by Alex Dolce, Florida Atlantic University
ST. PAUL, Minn., July 31 (UPI) — Doctors are routinely “underdosing” statins for patients at risk for heart attacks and strokes due to elevated levels of “bad” cholesterol, even though the drugs have proven safe and effective, a top U.S. researcher maintains.
At a time when an estimated 40% of U.S. adults have metabolic syndrome — a combination of heart risk factors including obesity, hypertension, dyslipidemia and insulin resistance — doctors usually don’t start them off with the maximum dosage of statins, even though they can quickly lower levels of LDL cholesterol, according to an opinion published this month in the medical journal Trends in Cardiovascular Medicine.
Co-author Dr. Charles Hennekens, the Sir Richard Doll Professor of Medicine and Preventive Medicine at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton, says his analysis of several major clinical studies of the new generation of highly potent statins, such as rosuvastatin and atorvastatin, shows that maximal doses are safe and sorely needed, but aren’t being prescribed.
Those with metabolic syndrome have cardiovascular risks equivalent to those with prior heart attacks or strokes, yet many are “undertreated” by starting their statin regimens at low or moderate dosages, Hennekens told UPI.
“The data indicate that over half of people who were put on a statin remain on the initial dose they’re given, so even though the intent may be to titrate it up, it’s not done in the majority of instances,” he said. “So, you get on a low dose of statin and you stay on it.”
But this “flies at the face of the data” showing that statins “have the strongest and most consistent body of evidence supporting their prescription in treatment and prevention in both men and women including older adults,” he said. “There’s no threshold for LDL below which you don’t see incremental benefits.”
The studies demonstrate newer statins can lower LDL, or bad cholesterol, in as quickly as a month and can provide related benefits, such as stabilizing the build-up of harmful plaque on the cells that line the interior surface of blood vessels, Hennekens said.
Therefore, he urges cardiologists who initiate drug therapies for those with metabolic syndrome to start statins at maximal tolerated levels.
“Everything points to getting on the highest dose of evidence-based statin,” he noted. “The goal of LDL in the high-risk secondary patients is less than 50 [milligrams per deciliter], and we have a lot to do to achieve that goal because there are lots of forces in society, especially in American society, that are making that more difficult.
“For example, in the United States today,