Heart Disease Prevention: Millions Could Be Prescribed Statins To Lower Cholesterol

Heart Disease Prevention: Millions Could Be Prescribed Cholesterol-Lowering Statins
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Millions more people in the UK could be prescribed cholesterol-lowering statins in a bid to prevent more cases of heart disease, heart attacks and strokes.

In draft guidance to the NHS, which is subject to consultation, the National Institute for Health and Care Excellence (Nice) has cut the threshold in half for when doctors should consider prescribing the drugs.

Statins are taken by as many as seven million people in the UK but this could rise dramatically - with experts predicting as many as five million more may have them prescribed.

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At present, people with a 20% risk of developing cardiovascular disease within 10 years are offered statins, but this is being cut to include all people with a 10% risk of developing cardiovascular disease within 10 years.

While Nice has yet to start work on how many extra people this could affect, evidence from Oxford University researchers shows millions more could take the drugs.

A 2012 Oxford University study, published in The Lancet medical journal, showed that even very low-risk patients benefited from statins.

Story continues below the slideshow:

7 Proven Ways To Prevent Heart Disease
2,000 extra daily steps = 10% lower risk(01 of07)
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In this global study, adults over 50 who were at high risk of cardiovascular disease and diabetes who walked an additional 2,000 steps a day—about 20 minutes of brisk walking—reduced their risk of having a cardiovascular “event,” such as a heart attack or stroke, by 10 percent over the next six years. “Other than not smoking, nothing comes close to physical activity for prevention,” says Dr. Church. “Hundreds, if not thousands, of papers support it.” Achieving the goal of being physically active for 150 minutes a week, including strength training a couple of days a week, can reduce your cardiovascular risk by about 25 percent, he says. “There’s a dose response, which means the more you exercise, the more you benefit.” The biggest benefit, though, comes from going from sedentary to mildly active, such as walking 10 minutes a day. Says Dr. Church, “The biggest bang is just getting off the couch.” (credit:Shutterstock)
An 7 extra grams of fiber daily = 9% lower risk(02 of07)
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In a meta-analysis of 22 studies, British researchers found that people who ate seven more grams of dietary fiber had a nine percent lower risk of heart disease. How much is that? A medium apple has 5 grams of dietary fiber, as does a half cup of cooked broccoli. A half cup of cooked lentils: 8 grams. Fruits, vegetables, beans, nuts, and whole grains are all good sources of fiber. “Fiber has beneficial effects on blood glucose and cholesterol, and it may keep your gastrointestinal tract healthier, reducing inflammation,” says Dr. Church. “Eating more fiber is also a marker of a healthier diet.” (credit:Shutterstock)
Daily glass of wine = 25% lower risk(03 of07)
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“It’s pretty powerful,” says Dr. Church. “Drinking in moderation cuts your risk of heart disease by about 25 percent.” That’s defined as no more than one daily drink for a woman, two for a man. Not everyone can drink moderately, of course, but if you can, research shows it’s heart healthy.“It relaxes your blood vessels, so you can’t form a clot while alcohol’s on board,” says Dr. Church. “Any alcohol has benefits, but wine has a little more,” says Dr. Church. The healthiest pattern: “A drink or two every couple of days.” (credit:Shutterstock)
Multivitamins = zero heart benefit(04 of07)
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The Agency for Healthcare Research Quality, a federal research agency, recently concluded that simply taking a multivitamin/multimineral pill won’t reduce your risk of heart disease. “It’s no surprise,” says Dr. Church. After all, preventing heart disease isn’t what multis are built to do—they’re to shore up nutrient deficiencies. “While the evidence for heart disease prevention isn’t there,” says Dr. Church, “taking multis won’t hurt you.” As for research that low vitamin D is associated with a 27 percent increased risk of developing heart disease, Dr. Church thinks it’s simply a marker for an inactive lifestyle, meaning since most people get their vitamin D from the sun, “people with high vitamin D levels are outside more—and probably more active,” he says. If you do have low D levels, Dr. Church supports taking supplements. But whether it will affect heart health isn’t fully clear. What he does think makes a difference: Omega 3 fatty acids, found primarily in fatty fish such as salmon. The American Heart Association recommends that healthy adults eat at least two fish meals a week. But if you don’t, won’t, or can’t, you may want to consider a 1-gram Omega supplement that includes both EPA and DHA, two forms of Omega 3s found in fish. While the heart disease preventive benefits of taking Omega 3 supplements hasn’t been established, says Dr. Church, “there is a lot of strong epidemiological evidence for Omega 3s. I’m a big proponent — I believe there’s value there.” (credit:Shutterstock)
Flu shot = 36% lower risk(05 of07)
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This one has a catch—it’s about people who already have heart disease. A recent analysis found that in people with existing heart disease, getting the flu shot reduces the risk of cardiovascular events like a heart attack by 36 percent. “Getting the flu puts great stress on your body and increases the risk of having another heart attack,” says Dr. Church. A flu shot is a good idea for everyone—it’s not too late since flu peaks around the end of February, beginning of March!—and if you’re at high cardiovascular risk, or already have heart disease, that little jab could be a lifesaver. (credit:Shutterstock)
Mediterranean Diet = 30% lower risk(06 of07)
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A major Spanish study found that men and women aged 55 to 80 who ate a Mediterranean diet were 30 percent less likely to have a heart attack or stroke, or die from heart disease, over the next five years. The most protective elements: olive oil as the primary fat, moderate alcohol (mostly from wine), lots of fruits, vegetables, nuts, legumes, and fish, and low consumption of meat. Just this week, a new American study of firefighters from the Midwest who followed a Mediterranean-style diet had lower cardiovascular risk factors: less belly fat, lower “bad” LDL cholesterol, and higher “good” HDL cholesterol. The great thing about Mediterranean studies is that they capture not just one healthy element but a pattern—a lifestyle. “We should look at risk factor clusters, and the Mediterranean lifestyle captures that,” says Dr. Church. Add the physical activity that’s part of a traditional Mediterranean lifestyle, and it’s really the big picture. (credit:Shutterstock)
A healthy lifestyle = 25% less chance of dying from heart disease(07 of07)
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Talk about big picture. The Centers for Disease Control and Prevention recently estimated that if everyone didn’t smoke, ate a healthy diet, exercised regularly, achieved a healthy weight, and got regular checkups so they could control risk factors such as high blood pressure and elevated cholesterol levels, then death from heart disease would fall by 25 percent. That’s 200,000 lives saved – each year. (credit:Shutterstock)

Rory Collins, professor of medicine at Oxford University, worked on the research and said the number of people who could begin taking statins as a result of the new Nice guidance "would be in the the order" of around five million.

He added: "The evidence is very strong that the treatment is cost-effective at these lower levels. Doctors are now in a position to offer statins on this basis."

He said it was up to individual patients to decide whether they wanted to take statins, based on their risk assessment, but Nice's strategy would "reduce the burden on the health service".

He went on: "People say you are medicalising the population by recommending statin use at these lower levels.

"That's complete nonsense. This remains a choice for the patient, it's not mandatory."

He said doctors and patients could work together to understand how much benefit an individual patient would receive from statins.

"If they are at high risk then doctors will be saying to patients they will get a big benefit, but at lower levels the benefits will be smaller and the patient has the choice," he said.

"Before, if the patient had lower levels of risk - despite it being cost-effective for them to get the treatment - they would not have had that choice."

Professor Colin Baigent, from the Oxford University team, calculated that lowering the threshold to a 10% risk - as Nice now proposes - would lead to around five million more people in the UK taking the drugs.

This in turn would save 2,000 lives and prevent 10,000 heart attacks or strokes every year, he said.

Another reason behind Nice's new recommendation is that the price of statins has dropped considerably in recent years to just a few pence per pill.

Statins are a group of medicines that help lower rates of low-density lipoprotein (LDL) cholesterol - so called "bad cholesterol" - in the blood.

They do this by cutting production of LDL cholesterol inside the liver.

Find out which foods contain good cholesterol in our gallery below:

Good Cholesterol Foods
Oats And Barley(01 of12)
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When it comes to heart health, we can't stop singing the praises of oatmeal. But other grains, like barley, are also healthy picks. Both are packed with fiber -- which helps keep you full for longer so you reach for the chips less. But fiber does more than just keep you slim. Soluble fiber, the kind that the body can digest, seems to reduce the amount of cholesterol the body absorbs from the intestines, lowering total cholesterol and LDL or "bad" cholesterol in the process.Flickr photo by Mr. T in DC (credit:Flickr:Mr. T in DC)
Fish(02 of12)
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You might think that fatty fish could be detrimental to your ticker, but the right seafood can lower cholesterol for a couple of reasons. First, eating more fish might mean that you're replacing meat in your diet, and meat contains more LDL-boosting saturated fats. Second, fish like salmon, sardines and albacore tuna are high in omega-3 fatty acids, which have been shown to lower triglycerides.Flickr photo by DesheBoard (credit:Flickr:DesheBoard)
Nuts(03 of12)
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Toss them in salads, sprinkle them on oatmeal or snack on them by the perfectly-portioned handful. Just about any variety of nut can lower total cholesterol, LDL and triglyceride levels, according to a 2010 analysis of data from 25 studies on nut consumption.Flickr photo by tvol (credit:Flickr:tvol)
Olive Oil(04 of12)
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Swapping the saturated fats found in butter for the unsaturated ones in oils is a good idea for both your waistline and your heart. Doing so can help reduce total cholesterol, but using olive oil in particular may also increase HDL, or "good" cholesterol. (credit:Alamy)
Apples(05 of12)
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A medium-sized apple contains about 4 grams of LDL-lowering soluble fiber, or about 17 percent of your recommended daily intake. An apple a day can keep the heart doctor away!Flickr photo by manitou2121 (credit:Flickr:manitou2121)
Strawberries(06 of12)
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Strawberries are rich in pectin, a type of soluble fiber that can lower LDL. One study found that supplementing a heart-healthy diet with strawberries had similar results to adding oats to a heart-healthy diet -- and tasted better, too!Flickr photo by Plinkk (credit:Flickr:Plinkk)
Citrus Fruits(07 of12)
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You'll also find pectin in oranges, grapefruits and other citrus fruits. And adding more fiber to your diet can lower blood pressure and reduce inflammation, both of which help your heart.Flickr photo by little blue hen (credit:Flickr:little blue hen)
Beans And Lentils(08 of12)
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Kidney, navy, garbanzos -- your favorite beans and lentils are all great sources of soluble fiber, which helps keep you full and can reduce cholesterol. A 2008 study from Arizona State University found that people who ate a half-cup of beans a day (at the time, the recommended amount according to the U.S. Dietary Guidelines for Americans) over a 24-week period lowered their cholesterol by 8 percent. If you eat around 2,000 to 2,500 calories a day, aim for a cup and a half to two cups of beans a week.Flickr photo by tomcensani (credit:Flickr:tomcensani)
Soy(09 of12)
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Like with fish, if you're eating soy, chances are you're eating less meat, which is higher in saturated fat and cholesterol. Soy is unique in the fact that it's a great source of protein, and yet it's free of any animal products, so it's also cholesterol free. However, it's not the cholesterol-busting superpower it was once touted to be. A 2010 study found that eating soy can result in a moderate 8 to 10 percent decrease in total cholesterol.Flickr photo by Rooey202 (credit:Flickr:Rooey202)
Red Wine(10 of12)
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You probably already know that a little alcohol -- in moderation of course -- is good for you. Part of the reason why? A 2000 study established that occasion clinking of glasses can raise HDL, or "good" cholesterol.Red wine may be particularly beneficial, since it's rich in antioxidants, which may lower LDL levels.Flickr photo by Dinner Series (credit:Flickr:Dinner Series)
Avocados(11 of12)
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Like olive oil, avocados are rich in cholesterol-lowering unsaturated fats. Monounsaturated fats, the ones found in the creamy green fruit, may lower LDL and raise HDL -- but probably only if you are replacing unhealthier dietary fats with these heart-healthy ones.Flickr photo by annethelibrarian (credit:Flickr:annethelibrarian)
Green Tea(12 of12)
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The miracle drink has been linked to everything from fighting cancer to keeping the mind sharp, but few studies have truly explained why green tea is such a powerful health elixir and just how much of it you'd need to drink to see results. While it does appear to lower "bad" cholesterol, it's only a slight reduction -- and you'd probably have to drink quite a few mugs full to see a difference. Chugging green tea isn't a good idea for everyone; it can interfere with some medications.Flickr photo by Qfamily (credit:Flickr:Qfamily)

High-rates of LDL cholesterol are linked to hardening and narrowing of the arteries, which can cause heart disease, heart attacks and stroke.

People can lower their risk naturally by eating a healthy diet, low in saturated fats, and increasing the amount of omega 3 fatty acids in their diet.

The new Nice guidance says doctors should encourage at-risk patients to stop smoking, cut down on alcohol, take exercise and eat a healthy diet.

Once these factors have been addressed, high intensity statin therapy should be offered to patients.

According to Nice, as many as seven million people in the UK are on statins, at an estimated annual cost of £450 million.

Professor Mark Baker, director of the centre for clinical practice at Nice, said: "People should be encouraged to address any lifestyle factors such as smoking, drinking too much or eating unhealthily.

"We also recommend that statins are now offered to many more people - the effectiveness of these medicines is now well proven and their cost has fallen."

Prof Baker said as well as taking statins, people with raised cholesterol levels and high blood pressure should reduce the amount of foods containing saturated fat they eat, such as meat, cheese and milk.

He said they should exercise more, stop smoking and control their blood glucose levels by reducing their intake of sugar and by losing weight.

According to the NHS, minor side effects of statins include an upset stomach, headache or insomnia. More serious side effects are rare but include kidney failure.

Professor Peter Weissberg, medical director at the British Heart Foundation, said: "Reducing your cholesterol level, whether that's through medication or lifestyle changes, will reduce your risk of cardiovascular disease.

"The current guidance weighed the benefits of taking a statin against what was then the considerable cost to the health service. This pragmatic decision made sure that those of highest risk benefited.

"However, as most people who have a heart attack or stroke have average cholesterol levels and since statins are now much cheaper it makes sense to reconsider the threshold."

A 2012 study from the British Heart Foundation found that 36% of people were failing to take their statins.

Some 28% said they stopped because their symptoms had vanished while 23% said they had suffered side-effects.

Cardiovascular disease is the leading cause of death in England and Wales. In 2010, one in three people died from it.

The NHS estimates that statins save 7,000 lives a year in the UK.