Everyone has friends and relatives (and maybe themselves) who go to their primary physician, who tells them their cholesterol reading is too high and that they should go on statins to reduce the risk of heart ailments and death. If they’re like my friends and relatives, they say, “Sure, Doc,” and just like that, they’re on statins (and maybe blood pressure medication too) for life.
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Earlier this year, the American College of Cardiology Foundation and the American Heart Association came out with a new, 2026 Guideline as to who should be on statins, widening the criteria (more about that in a moment) of those in the 2018 Guideline to take into account longer-term risk. A July JAMA study quantified the number of Americans for whom statins would now be recommended based on these new guidelines. It turns out to be 87.5 million Americans age 30-79, or 57% in that age range, including 21.5 million newly eligible based on the new criteria. The widened criteria (see Table 1 in the JAMA study) include widening the age interval from 40-75 to 30-79, stronger recommendations on borderline-risk patients and those with high cholesterol, inclusion of those with stage-3+ kidney failure and HIV, a lowering of the 10-year atherosclerotic cardiovascular disease risk thresholds, and the use of new equations deriving the risks.
Now, I’m not claiming to be a heart specialist or expert on statins, and I won’t question their calculations measuring the risk; after all, when was the last time medical establishment experts collectively were wrong? (Oh, right, that would be COVID.) And I’m aware that there are those with physical limitations, or those otherwise in great shape but due to genetics have high readings they just can’t bring down no matter what they do. But something sounds way wrong to me that 57% of Americans in such a wide age-group range “need” to be on statins for life, and how blithely and readily the heart associations will put them on it.
It does not inspire confidence that know-it-all public health “experts” who were dead wrong about everything COVID, like CNN wellness expert Dr. Leana Wen, are all-in on this, but this is much bigger than them, as basically the entire cardiology profession is as well.
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Aside from health behavior counseling being added to the recommendations, the above-mentioned guidelines devote just one section (4.1) to lifestyle management. The section is just six pages long (a good chunk taken up by charts and figures), despite an admission that those with healthy lifestyle habits have a 50% relative risk reduction in adverse cardiovascular disease outcomes. It doesn’t feel like the heart associations’ “heart” is really into lifestyle management.
Now, I get that most of my friends and relatives mentioned above, who often are addicted to sugar-laden and heavily-fried foods, and view a gym or a run as a foreign concept, are significantly overweight and inactive, and other than a willingness to take glp-1 drugs (which probably pay, but common side effects include nausea and vomiting, and risks include blindness and the consequences of muscle mass loss), just do not have the discipline and will to adopt a strenuous exercise program and healthy eating. But to just throw your hands up and say, therefore, everyone should get on statins for life (risks include muscle pain and increased incidence of diabetes) seems so wrong. If the main drivers of the need for statins are overweight, inactivity, and unhealthy eating habits, shouldn’t the medical establishment prioritize lifestyle changes as a national health priority — even emergency — similar to the assault on smoking? The success of such a program would have the added bonus of depriving the pharmaceutical companies of running up excess profits on the foibles of mankind.
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W.A. Eliot is a pseudonym
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