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\t\t\t\t\t\tStatins don\u2019t cause most of the side effects on package warnings, study finds<\/a><\/p>\n The new calculator had raised concern over the past 16 months. If used in tandem with existing thresholds for treatment, it turned out, far fewer people would qualify for a statin. Many people already don\u2019t take their prescribed statins, so diminishing the number eligible by as much as 40%<\/a> was feared as a failure of prevention.\u00a0<\/p>\n The new 2026 guidelines embrace the new PREVENT equations (short for Predicting Risk of Cardiovascular Disease EVENTs), and they also adjust the threshold for taking action to clear arteries of fatty plaque. The optimal level of LDL is lower and the risk threshold for prescribing better diet and physical activity, drugs, or both has also been adjusted downward.<\/p>\n Timothy Anderson, a primary care physician and assistant professor of medicine at the University of Pittsburgh Medical Center, was one of the researchers raising concerns about matching PREVENT to risk thresholds. Also a member of the 2026 guidelines writing committee, he praised the PREVENT equations as a well validated risk estimation tool with updated accuracy.\u00a0<\/p>\n \u201cThe full rationale is really this idea of trying to balance the potential benefit of lipid-lowering therapies like statins against the potential risks,\u201d he told STAT.\u00a0 \u201cA real focus of the guidelines is identifying and treating high cholesterol earlier on, out of the hypothesis that long-term exposure to high cholesterol may have greater risks than short-term exposure.\u201d<\/p>\n Earlier recognition<\/p>\n Earlier intervention means looking at 10-year risk estimates as well as 30-year predictions.\u00a0<\/p>\n The new PREVENT equations classify 10-year cardiovascular disease risk from plaque-lined arteries as low (under 3%), borderline (3% to 5%), intermediate (5% to 10%), and high (10% or higher). These risk categories form the foundation for treatment decisions, from starting statin therapy to determining intensity of lipid lowering. A composite of other factors, including family history, inflammatory disease, diabetes, kidney disease, cancer, HIV, and certain reproductive conditions, influence how risk is calculated.<\/p>\n Treatment is now recommended at much lower LDL levels for people, depending on their current health. To prevent a first heart attack or stroke, LDL should be under 100 mg\/dL for those at borderline or intermediate risk and under 70 mg\/dL in those at high risk. But in people who already have fatty buildup in their blood vessels deemed at very high risk of heart attack, stroke, or peripheral artery diseases, the LDL goal drops to under 55 mg\/dL.<\/p>\n Roger Blumenthal, chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, compared lipid-lowering drugs to medications to reduce blood pressure. The longer both are in control, the better, yielding much stronger protection against future heart attack and stroke risk. That argues for looking at 10-year risk estimates as early as age 30.<\/p>\n \u201cThe PREVENT score gives us a good educated guess, but keep in mind these numbers are pretty low when we talk about intermediate risk being a 5% to 10% 10-year risk,\u201d he told STAT. \u201cSome patients have already said, \u2018Well, Dr. Blumenthal, that\u2019s a 1 in 20 chance that I\u2019ll get a cardiovascular event.\u2019 That\u2019s very true. But I tell them that if you have other factors that support earlier treatment, that may sway us to being more aggressive and in your management.\u201d<\/p>\n Other factors that influence risk<\/p>\n \t\t\t \t\t\t\t\t\t6 in 10 women will develop heart disease or stroke by 2050, heart association projects<\/a><\/p>\n Beyond family history, those risk enhancers include being overweight or obese, diabetes, and chronic kidney disease, as well as chronic inflammatory conditions such as lupus or rheumatoid arthritis. Having South Asian or Filipino ancestry also means a higher risk for developing atherosclerosis.<\/p>\n Women tend to develop atherosclerotic disease about 10 years later than men, but that delay is erased if they experienced early premature menopause, preeclampsia, gestational diabetes, or hypertension during pregnancy. \u201cIf they have one of these reproductive risk markers of increased cardiovascular risk, then that, I think, will lead to more clinicians and patients thinking about being much more aggressive in their lifestyle habits and, if necessary, using a medicine to lower their cholesterol,\u201d Blumenthal said.<\/p>\n Markers in the blood other than cholesterol have drawn more attention in recent years. Lipoprotein(a), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein are considered important in establishing someone\u2019s risk. Lp(a), shaped by genetics and shared by about 1 in 5 people worldwide, should be measured once over a lifetime, the guidelines say. Having levels 50 mg\/dL or higher is associated with about a 40% increased long-term risk of heart attack or stroke. Lifestyle changes don\u2019t alter Lp(a) levels, but high Lp(a) combined with high LDL should signal a conversation about lowering LDL. Blumenthal said Lp(a) could be a tiebreaker in someone on the cusp for treatment.\u00a0<\/p>\n In people with cardiovascular-kidney-metabolic syndrome, type 2 diabetes, high triglycerides, or known cardiovascular disease who have reached their cholesterol goals, ApoB may be a more accurate risk marker for future cardiovascular disease than LDL cholesterol, the guidelines say.<\/p>\n The role of statins<\/p>\n Throughout the 123 pages of guidelines, the emphasis is not just on statins or LDL cholesterol. Recognizing that all who might benefit don\u2019t take statins, the authors still accord them a place in early treatment.<\/p>\n The workhorses of cardiovascular disease prevention have long been sold at about $40 a year. Their introduction in the 1980s has been compared to today\u2019s obesity drugs for the scale of their impact in preventing heart attacks, strokes, and peripheral artery disease. One downside has been the mismatch between who could benefit and who actually takes the medications.\u00a0<\/p>\n There are side effects, and fear of them. Some people feel muscle pain and others see their blood sugar rise enough to develop type 2 diabetes, an absolute risk increase that studies estimate<\/a> ranges from 0.1% to 0.5%. Blumenthal said 95% or more patients have no difficulties on the drug.<\/p>\n Jeremy Sussman, a primary care physician at the VA Ann Arbor Healthcare System who was not involved in drafting the guidelines, believes statins are very valuable medicines, but is concerned about patients who might think taking a statin would be too aggressive. While their chances of developing muscle pain or diabetes are small, their\u00a0reduced odds of having a heart attack or stroke may also appear small at first, falling only gradually over time.<\/p>\n \u201cFor many of us, that\u2019s worth it since a heart attack can be a terrible thing,\u201d he said via email, \u201cbut it\u2019s worth recognizing that we are encouraging a huge amount of statin use that will only benefit over a very long time period.\u201d<\/p>\n Sussman also said it\u2019s regrettable that primary care physicians were not represented in the medical societies that wrote the guidelines. He also called the guidelines insufficiently patient-centered, important when so many people at risk stop taking cholesterol-lowering medications within two years of starting them.<\/p>\n \u201cThe most difficult questions in dyslipidemia treatment are rarely if or when a patient has high enough risk or cholesterol level. It\u2019s trying to understand the patient\u2019s values and how doctors and patients together can decide if a patient should overcome their dislike of medicines to start a pill today for a goal of preventing a heart attack in 20 years,\u201d he said, adding, \u201cThese issues are acknowledged, but the guideline does not give much guidance on these partnered issues.\u201d\u00a0<\/p>\n Not just statins<\/p>\n Statins aren\u2019t the only drugs for cholesterol control. They can be taken with other, more powerful drugs if lipids stay high. In the mix are PCSK9 inhibitors, drugs that block a protein to shrink LDL cholesterol.\u00a0<\/p>\n \t\t\t \t\t\t\t\t\tFor heart health, low-carb or low-fat diet works, as long as it\u2019s high quality: study<\/a><\/p>\n In an editorial published along with the guidelines in JACC<\/a> and Circulation<\/a>, Blumenthal described a trial of a PSCK9 inhibitor<\/a> in detail. The data about using the drug in people before a first heart attack were presented at the AHA\u2019s scientific session in November 2025, too late for the guidelines but a harbinger of research to come. The guidelines will be updated annually to provide resources for physicians.<\/p>\n \u201cWith PCSK9 inhibitors that had short-term follow-up of about two to three years, there was about a 15% to 20% relative risk reduction on top of statin therapy,\u201d Blumenthal said, with a big but: \u201cStatins are so much more economically feasible than a PCSK9 inhibitor and insurance companies would much rather pay for a generic statin than a medication that might cost the patient $5,000 a year.\u201d<\/p>\n In addition to blood tests for high lp(a), Apo(b), and the more familiar fat-storing triglycerides, there is a test called a coronary artery calcium scan to help with decisions about taking a statin. When someone\u2019s risk is uncertain, the scans can reveal calcium and plaque buildup in artery walls. The tests are recommended for men age 40 and up and women age 45 and up who are living with borderline or intermediate 10-year risk of heart attack or stroke. The 2018 guidelines had suggested them only for people at intermediate risk.<\/p>\n In Blumenthal\u2019s view, there are now many ways to identify a person at higher risk. That\u2019s not the challenge it once was.<\/p>\n \u201cThe hardest thing really is to motivate people to improve their lifestyle habits,\u201d Blumenthal said. \u201cBut it\u2019s also hard many times to get people to understand that we have such a multitude of great data about lower is better for longer. If we can motivate people to keep striving to improve their lifestyle habits earlier, then there\u2019d be less of a need for medication and less of the need for dealing with all these acute cardiac events that unfortunately plague so many people in the United States and worldwide.\u201d<\/p>\n STAT\u2019s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies<\/a>. Our financial supporters<\/a> are not involved in any decisions about our journalism.<\/p>\n","protected":false},"excerpt":{"rendered":"Leading medical organizations on Friday recommended major changes in cardiovascular disease prevention, saying people as young as 30…\n","protected":false},"author":3,"featured_media":654900,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[40452,11399,210,10943,881,67,132,68],"class_list":{"0":"post-654899","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-cardiovascular-disease","9":"tag-chronic-disease","10":"tag-health","11":"tag-obesity","12":"tag-public-health","13":"tag-united-states","14":"tag-unitedstates","15":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/116227198743111767","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/654899","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=654899"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/654899\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/654900"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=654899"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=654899"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=654899"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2026\/03\/AP25228073183977-768x432.jpg\")
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