Tag Archives: ACC

What is your ‘Statin by date’?

Somewhat to my chagrin, I filled in my risk factors into the new ACC/AHA guidelines on cardiovascular disease prevention. I now find that I should have started statins eight weeks ago. Naughty, naughty, me. My blood pressure was a bit higher than the calculator liked 138/82, my cholesterol quite a bit higher at 6.0mmol/l.

Which means that I have already passed the 7.5% ten year risk score. O….M…..G. (I think my picture makes me look a bit younger than I am, although it was only taken last year – honest)

What to do?

I am now well beyond my ‘Statin by date.’ No longer can I be healthy without taking a statin. By the way, a friend came up with the concept of ‘statin by date.’ It did make me laugh, conjuring up the image of a sell by date on a can of baked beans. Or maybe Logan’s run. If you remember that film, once you reached the age of, I think it was thirty, you had to leave the colony as you had reached your sell by date.  ‘No this is not au-revoir…. It is goodbye.’

Can I be reassured that my parents are both alive and healthy in their late eighties. My grandmother, on my mother’s side, lived to one hundred and two. No idea about my father’s side. WWII did for both my grandparents on that side.

Can I feel comfort in the fact that I play squash three times a week, go to the gym twice a week and walk when I can? Mind you all of this is wiped out by my excess consumption of alcohol I suppose – unfortunately. Also, I am in the overweight category with a BMI, of 28. But wait, isn’t the entire English rugby team obese, using the BMI. Must be all the training and muscle bulk that does it. Yes, the jolly old BMI.

No, I thought I was a pretty healthy chap. I have no real risk factors for heart disease at all. A resting pulse rate of 48, a reasonable blood pressure……

In truth I feel terribly sorry for the Swiss. They have the highest average cholesterol level in Europe at 6.4mmol/l (250mg/dl in those inconvenient US units). Surely the entire nation must be put on statins straight away. But, hold on, wait just one gosh darned minute. Don’t they have the second lowest rate of heart disease in Europe?

Why yes, they do. Only beaten by the French. Who have an average cholesterol levels higher than most other countries, they also eat the most saturated fat in Europe, and yet they have the lowest rate of heart disease. About one quarter that of the UK and US. I wonder how the ACC/AHA calculator works for them? Perhaps not that well.  Ah oui, bonne chance. Zey must be, ‘ow you say ‘une paradox’. (Or would that be ‘un paradox’)

As you can tell I think I am grasping at straws. Who am I to attempt to stand against the massed intellectual power of the ‘experts.’ The reality is that I feel the breath of the grim reaper on the back of my neck, scythe in hand. I am now eight weeks past my statin by date, and I am not taking statins. The clock ticks in the background, I can sense the disapproval of cardiologists around the world weighing heavily upon me.

‘Forgive me father, for I haven’t statined.’

You need a statin – now what was the question?

As many of you are aware the American College of Cardiology (ACC) and the American Heart Association (AHA) came out with new guidelines on cardiovascular disease prevention a few days ago. As part of this, they produce a risk calculator. Using this calculator, if your risk of heart attack or stroke is greater and 7.5% over the next 10 years, you should take a statin – for the rest of your life.

I downloaded this calculator, and I have been playing around with it. I think I would tend to agree with the headline in the NY times 18th November 2013:

Risk Calculator for Cholesterol Appears Flawed

To be frank you can fiddle around with the figures on this calculator for hours. I think my OCD is getting worse. (Maybe I should take a statin to cure my OCD). One of the questions I wanted to find an answer to was the following, at what age would a perfectly healthy man (with ‘optimal’ risk factors) have to take a statin for the rest of his life.

So, I fed in the figures, and use the ‘optimal’ figures for cholesterol and blood pressure on the risk calculator

THE PERFECTLY HEALTHY MAN

  • Male
  • Age 63
  • Race: WH (white)
  • Total cholesterol 170mg/dl [This is 4.4mmol/l in Europe i.e. very low]
  • HDL cholesterol 50md/dl [This is 1.3mmol/l in Europe]
  • Systolic blood pressure 110mmHg
  • Non-smoker
  • No treatment for high blood pressure
  • Non diabetic

CV risk over the next 10 years = 7.5%

So, there you are. You can do absolutely everything ‘right’ be as healthy as healthy can be – according to the AHA and ACC. Yet, by the age of sixty three you need to take a statin – for the rest of your life.

The next question I wanted to find the answer to was, at what age does a ‘normal’, very healthy man have to start using a statin? In the UK, the average total cholesterol for men is 5.0mmol/l. [this is 193mg/dl in the US]. The average blood pressure in the UK systolic is 129mmHg.  (To be frank, I think the average cholesterol level for men is higher than this, but the WHO says not).

Feed these figures in, and you would need to start taking a statin, for the rest of your life, by the age of fifty eight. Which means that very healthy men, with no real risk factors for cardiovascular disease – at all – have to start statins at fifty eight.

What of women. Well, they get another seven years of statin free life. A super healthy woman, with optimal risk factors, reaches the dreaded 7.5% risk aged 70. An ‘average’ healthy women, with average BP and cholesterol levels, would have to start a statin aged sixty three.

In summary, using this risk calculator, extremely healthy men will be starting statins at fifty eight, and very healthy women at sixty three. This, then, marks the age at which life becomes a statin deficient state. You can be as healthy as healthy can be. You can do everything right, have no risk factors at all for cardiovascular disease, and yet you still need to take medication to reduce the risk of cardiovascular disease.

Sorry, what was the question again?

European cardiovascular disease statistics can be found here.