Employee Benefits Professionals need to understand the role statins play in helping employees lower their cholesterol levels.
Why? Because high cholesterol contributes to atherosclerosis or hardening of the arteries, which leads to cardiovascular disease or myocardial infarctions (a.k.a. “heart attacks”), the No. 1 cause of death in the United States.
Common statins include:
- Atorvastatin (generic Lipitor)
- Rosuvastatin (generic Crestor)
- Simvastatin (generic Zocor)
- Pravastatin (generic Pravachol)
- Lovastatin (generic Mevacor)
The U.S. Preventive Services Task Force (USPSTF) recommends the use of statins for the primary prevention of cardiovascular disease.
- Primary prevention means preventing a heart attack before it happens. It is relevant to employee benefits professionals because the vast majority of plan members have NOT had their first heart attack.
- Secondary prevention means preventing something from happening again—i.e. preventing a second heart attack after surviving the first one. The use of statins in secondary prevention is well established.
New Research: Having High Cholesterol is Not Enough Reason to Take Statin Medications
The Journal of the American Medical Association (JAMA) recently published an entire issue dedicated to the latest findings and stance of the USPSTF on the use of statins for the primary prevention of cardiovascular disease.
The article states that statin mediations are indicated for adults between the ages 40 and 75 with no history of cardiovascular disease and at least 1 cardiovascular disease risk factor (i.e. dyslipidemia or high cholesterol, diabetes, high blood pressure or smoking) AND who have a 10-year cardiovascular event risk that is greater than or equal to 10 percent (i.e. 1 in 10 chance of having a heart attack in the next 10 years).
How Employees Can Determine Their 10-Year Cardiovascular Event Risk
The American College of Cardiology provides an online calculator that helps employees determine their 10-year cardiovascular risk is. To fill out this calculator, employees need to know:
- Total Cholesterol
- HDL Cholesterol
- Systolic Blood Pressure
- Diastolic Blood Pressure
- Whether or not you are being treated for High Blood Pressure
- Whether or not you have Diabetes
- Whether or not you Smoke
In other words, the use of a statin is based on 10-year risk, NOT solely on how high someone’s cholesterol is. For example, another article in the JAMA issue entitled “Evolving Approaches for Statins in Primary Prevention” states that a 41-year-old man with high blood pressure and high cholesterol (Total Cholesterol = 245, LDL=155, HDL=50) would have a 10-year risk of 2 percent and therefore, would NOT be recommended to take a statin per the USPSTF recommendations. He clearly has high cholesterol, but it’s not necessarily need to take a statin.
Another article in the JAMA issue, entitled “Statins for Primary Prevention: The Debate is Intense, but the Data are Weak,” states that 244 patients would need to take a statin daily to prevent one death over a five-year period.
How Employee Benefits Professionals Can Work with Employees with High Cholesterol
In the real world, this means if you were the Head of Benefits for a large company and you had 500 plan members taking a statin for primary prevention of cardiovascular disease, these 500 people would need to take a statin every day to prevent about 2 deaths over the course of 5 years.
- Your plan members who have had a heart attack should likely be taking a statin for Secondary Prevention.
- Your plan members who have NOT had a heart attack would need to follow a fairly complex medical algorithm to determine if they should be taking a statin for Primary Prevention. That algorithm is probably best reviewed with a primary care physician during a preventive physical exam.
- The vast majority of your plan members are like No. 2, not No.1.
- High cholesterol alone is not reason enough to be prescribed a statin for primary prevention. Many plan members with high cholesterol do not meet criteria to take a statin.
- You need to have a fairly large number of plan members who should be on a statin medication actually take a statin every day to improve health outcomes in your population.
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