US Pharm. 2016;41(2):1.
It’s human nature to focus on health issues that cause the most discomfort in the given moment—an excruciating toothache, for example. What is it they say? The squeaky wheel gets the grease?
Another example is high cholesterol, a largely silent problem—until a heart attack or stroke occurs as the result of arterial blockage associated with it. Many of us exercise regularly so that we keep our hearts healthy and strong, yet we might forego regular screening for cholesterol; I am sometimes guilty here. With our hectic work and home schedules, even a brief visit to a doctor for a rudimentary blood test is oftentimes inconvenient.
This complacency, however, can prove dangerous. According to the American Heart Association’s (AHA) 2016 Statistical Update, just 46.6% of adults in the United States have the desirable untreated total cholesterol levels of less than 200 mg/dL; thus, more than half of adults have higher total lipid numbers. Prevalence of ideal levels has improved over the past decade in children but has remained the same in adults. According to 2009 to 2012 data, nearly 31 million of us had total cholesterol levels of 240 mg/dL or higher.
Current AHA guidelines recommend statin therapy for the following groups: people without cardiovascular disease who are aged 40 to 75 years and have a 7.5% or higher risk for having a heart attack or stroke within 10 years; people with a history of a cardiovascular event, such as a heart attack or stroke; people aged 21 years and older who have a very high level of bad (LDL) cholesterol (190 mg/dL or higher); and people with type 1 or type 2 diabetes who are aged 40 to 75 years.
The case for not knowing one’s cholesterol numbers is increasingly less defensible, partly because health screenings offered at pharmacies frequently include blood lipid profiles. Frustrated with the appointment process at my physician’s office recently, I visited a local pharmacy and underwent a lipid test and other assessments such as blood pressure—all with no appointment!
With some significant cardiac disease sprinkled in my ancestral health profile, I really need a convenient way to monitor my lipid levels. My paternal grandfather, in fact, succumbed to a heart attack at age 50. With this ominous strain lurking in my family health background, I am very careful to check my cholesterol.
The greater availability and affordability of statins, by virtue of Lipitor and other lipid-lowering medications coming off patent, offer yet another weapon against high cholesterol—and an effective one at that! In a study published in late 2014 in the Annals of Internal Medicine, researchers from Brigham and Women’s Hospital, Harvard Medical School, and CVS Health looked into the role that generics versus brand-name statin drugs play in adherence and health outcomes. They found that patients with an average age of 76 years who were taking generic statins were more likely to stick with their treatment; they experienced an 8% lower rate of heart attack, stroke, and death compared to those taking a brand-name statin.
Patients who might be reluctant to use generic statins should be counseled that although the FDA does not require generics to contain the same inactive ingredients as their brand counterparts, they must contain the same active ingredient in the same strength, dosage form, and administration route.
Many patients in the U.S., whether they are using generic or brand-name statins, are clearly taking heed to check and treat their high cholesterol. According to the AHA’s 2016 Statistical Update, from 2003 to 2012 the percentage of U.S. adults aged 40 years or older who had used a lipid-lowering medication in the past 30 days increased from 20% to 28%.
Despite these promising statistics, I believe that many more people need to improve their cholesterol-monitoring habits. So even though they may feel fine, readers of U.S. Pharmacist and by extension their patients would do well to keep a watchful eye on their cholesterol numbers.
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