Hearts & Minds Blog
Getting to the Heart of the Matter for American Heart MonthFebruary 26, 2016
American Heart Month is a timely reminder that more still needs to be done for people at risk for cardiovascular disease.
As a lipid specialist, patients are frequently referred to me by their primary care physician because they are struggling to manage their patients’ elevated levels of low-density lipoprotein cholesterol (LDL-cholesterol), or “bad” cholesterol. Often this occurs because – although statins continue to be the backbone of lipid lowering therapy – not all patients, including many of my own, are able to tolerate the required dosage of statin needed to reach their LDL-cholesterol goals. Elevated LDL-cholesterol remains a critical risk factor for the development of cardiovascular disease. An alternative to statins, which is cost-effective for both patients and the healthcare system, is pivotal to advancing the treatment and care of patients with elevated LDL-cholesterol a crucially needed addition to the clinical armamentarium of health care professionals.
Elevated low-density lipoprotein cholesterol is a critical risk factor for cardiovascular disease.
In the U.S., more than 78 million adults have elevated LDL-cholesterol, placing these Americans at twice the risk compared to those who have normal levels. Of the millions of adults with elevated LDL-cholesterol levels, approximately half are obtaining the treatment they need to lower their levels, and fewer than 1 in 3 adults have their LDL-cholesterol levels under adequate control. 
Treatment of elevated LDL-cholesterol is imperative to reducing the risk of heart disease – unfortunately, some patients cannot tolerate current therapies.
Statins continue to be the mainstay of treatment of elevated LDL-cholesterol in the U.S.—their benefits in reducing LDL-cholesterol levels and the risk of coronary heart disease in a wide variety of patients are well-recognized and documented. However, in up to 10 percent of patients for whom statins are prescribed, 3.5 million individuals in the U.S. alone, the risk versus benefit of these agents can be a major question due to statin intolerance. Statin intolerance can lead to medication switching, poor adherence and discontinuation that may potentially lead to increased risk for cardiovascular events. As such, statin intolerance is a major U.S. and worldwide public health issue.
Physicians continue to look for alternative solutions for their patients with statin intolerance.
Thoughtful and judicious clinical judgement is essential when patients are unable to achieve reasonable reductions in their LDL-cholesterol levels as a result of statin intolerance. According to the Expert Panel on Statin Intolerance, “The decision on statin intolerance is the patient’s decision, based on subjective feelings, preference and judgement.” I often see patients referred for statin intolerance. These patients are looking for alternatives that will both lower their elevated LDL-cholesterol. Although statins unequivocally reduce cardiovascular risk, for patients with statin intolerance they are not a viable option. It is crucial that we continue to look for statin alternatives which may allow statin intolerant patients to live longer, healthier lives.
 Centers for Disease Control and Prevention (CDC). Prevalence of Cholesterol Treatment Eligibility and Medication Use Among Adults — United States, 2005–2012. http://www.cdc.gov/mmwr/pdf/wk/mm6447.pdf. Last accessed February 19, 2016.
 Centers for Disease Control and Prevention (CDC). CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioral Risk and Protective Factors—United States, 2005–2013. http://www.cdc.gov/mmwr/preview/mmwrhtml/su6304a2.htm. Last accessed February 19, 2016.
 Centers for Disease Control and Prevention (CDC). Cholesterol Fact Sheet. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/docs/fs_cholesterol.pdf. Last accessed February 19, 2016.
 Ahman, Zahid. Statin Intolerance. The American Journal of Cardiology. 2014: Volume 113, Issue 10, 1765-1771.
 Banach et al. Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Archives of Medical Science. 2015: Volume 11, Issue 1, 1-23.
 Jacobson et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 – executive summary. Journal of Clinical Lipidology. 2014: Volume 8, Issue 5, 473-488.