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Statins in the water? Not yet
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New Orleans — No one argued for universal statin therapy at Monday morning’s Plenary Session called “Statins in the Water?” but presenters agreed that determining whether lipid-lowering therapy is wise for patients at moderate risk for CV events remains a challenge.
Donald M. Lloyd-James, MD, at the Feinberg School of Medicine at Northwestern University, said that the Framingham Risk Score/ATP III Risk Assessment Algorithm is not useful for determining lifetime risk.
Physicians need a better way to calculate lifetime risk, a score that would “reflect a real-world sense of risk,” he said. Lloyd-James and his colleagues are devising a new risk estimator that would give a more realistic view of risk beyond 10 years.
Roger Blumenthal, MD, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, said that JUPITER results will change primary prevention strategies. Physicians will now be more likely to consider hsCRP levels in some patients to determine whether statin therapy should be used.
“For a lot of patients at moderate risk, it will be up to physicians to decide whether to use CRP or CAC as the tie-breaker,” Blumenthal said. Generic statin therapy would be reasonable, for example, for a woman over age 60 with one risk factor. If the patient is resistant to that type of long-term therapy, it would be reasonable to look at the patient’s hsCRP and CAC scores, he said.
Moderator Lori Mosca, MD, at NewYork-Presbyterian Hospital/Columbia University Medical Center, said that overweight continues to be a primary determinant of long-term risk for many people, with weight directly related to hsCRP levels. “If we can get people to control their lifestyles and weight in their 20s and 30s, we would not have to consider putting statins in the drinking water when they are in their 60s,” she said.