When Should Statin Therapy Begin for the Average American?

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The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
• Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
• Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
• Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

If you decrease a patient’s LDL level and keep it down, said Ferdinand, you can see greater benefits than have been reported in statin trials, and very robust coronary heart disease risk reduction can be achieved in patients who are treated when their LDL levels are already low. Watson pointed out that we are all born with low LDL levels unless we have a genetic abnormality, and then we raise them to typical adult levels over the course of our lifetimes.

Robinson explained that we are able to stabilize patients’ plaque rather than eradicate it, and so treating early “is a really good idea because they have less [atherosclerotic] burden.” In her opinion, the average American needs a statin by the age of 50 years. Ballantyne used the example of children with homozygous familial hypercholesterolemia who have very high LDL levels from a very young age, and he said that the earlier treatment is started for these patients, the better. However, for an average person with an LDL of 130, treatment depends on the patient’s risk, he said. “All the data suggested if you start early and go longer, you get more benefits,” he said.