New guidelines: Half of population between 40 and 75 years old should be on statin regimen
DURHAM, N.C. — New guidelines for using statins to treat high cholesterol and prevent cardiovascular disease are projected to result in 12.8 million more U.S. adults taking the drugs, according to a research team led by Duke Medicine scientists. Overall, of the 12.8 million additional U.S. adults recommended for statin use under the new guidelines, 10.4 million are people who would be prescribed the drugs for preventive care. Of those preventive users, 8.3 million would be people over the age of 60.
This could prove significant as Pfizer pursues a switch of Lipitor to nonprescription status.
The findings for the first time quantify the impact of the American Heart Association’s new guidelines, which were issued in November and generated both controversy and speculation about who should be given a prescription for statins.
In an analysis of health data published online March 19, 2014, in the New England Journal of Medicine, a team led by researchers at the Duke Clinical Research Institute found that most of the additional statin users under the new guidelines would be people older than age 60.
“We sought to do a principled, scientific study to try to answer how the new guidelines might affect statin use, particularly as they focused eligibility on patients with an increased risk of developing cardiovascular disease,” stated lead author Michael Pencina, professor of biostatistics at DCRI. “By our estimate, there might be an uptake in usage as a result of the guidelines, from 43.2 million people to 56 million, which is nearly half of the U.S. population between the ages of 40 and 75.”
Pencina and colleagues from McGill University and Boston University used the National Health and Nutrition Examination Surveys for their analysis, focusing on 3,773 participants between the ages of 40-75 who had provided detailed medical information, including fasting cholesterol levels from blood tests.
The new guidelines expand the criteria for statin use to include people whose 10-year risk of developing cardiovascular disease, including stroke, is elevated based on a risk-assessment score.
The DCRI-led research team determined that the new guidelines could result in 49% of U.S. adults ages 40-75 being recommended for statin therapy, an increase from 38%.
The increase is much more pronounced among adults free of cardiovascular disease who are over age 60, with 77% recommended for statin use under the new guidelines vs. 48% under the previous standards. This contrasts with a modest increase from 27% to 30% among U.S. adults between the ages of 40 and 60.
Those most affected by the new recommendations are older men who are not on statins and do not have cardiovascular disease. Under the earlier guidelines, about 30.4% of this group of men between the ages of 60-75 were recommended for statin use. With the new guidelines, 87.4% of these men would be candidates for the therapy. Similarly for healthy women in this age group, those recommended for preventive statin use are projected to rise from 21.2% to 53.6%.
“The biggest surprise of the research was the age-dependent split for those affected by the new guidelines,” Pencina said. “We anticipated that the impact would be age-dependent, but not to the degree observed. The changes for both men and women in the older age groups where huge compared to those between the ages of 40 and 60.”
The analysis also projects that an estimated 1.6 million adults previously eligible for statins under the old guidelines would no longer be candidates under the new standards. This group included primarily younger adults with elevated cholesterol but low 10-year risk of cardiovascular disease.
Pencina said an important limitation of the study is the necessary assumption that the new guidelines would be followed to the letter; in real life, people may be recommended for statins but decline to start the therapy.
“Recommendations are just that – recommendations,” Pencina said. “These guidelines correctly call for a thorough discussion between the doctor and patient about the risks and benefits of statins. It’s not like everybody who meets the guidelines should all of a sudden go on statins.”
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CHPA: Missouri voters oppose any proposal of a PSE prescription requirement
WASHINGTON — The Consumer Healthcare Products Association on Wednesday released the results of a recent poll of Missouri voters conducted by GS Strategy Group and supported by CHPA that found a clear majority of state residents oppose proposed legislation that would require a prescription for the purchase of pseudoephedrine. As many as 64% of respondents oppose the measure, and nearly 75% of respondents said it would at least be somewhat of an inconvenience to have to obtain a doctor’s prescription before buying those medicines.
"This survey provides strong evidence that the vast majority of Missouri consumers prefer effective solutions to the meth problem that don’t force law-abiding citizens to obtain a doctor’s prescription for popular nonprescription medicines," stated Carlos Gutierrez, senior director and head of government affairs for CHPA. "During the current legislative session, it is likely that some Missouri lawmakers will once again push for a prescription requirement for popular cold and allergy medicines. The public, however, clearly favors more balanced policy solutions."
Gutierrez noted that Sen. David Sater (R-Mo.) and state Rep. Stanley Cox (R-Mo.) have introduced measures that would focus squarely on meth criminals. "One of the ideas advanced by Sen. Sater and Rep. Cox is the implementation of a meth-offender block list that would bar individuals convicted of drug felonies from purchasing pseudoephedrine-based cold and allergy medicines," he said. "Oklahoma adopted a meth-offender block list in 2012 and has experienced a 50% drop in meth-lab incidents since then."
This will not solve the meth problem in Missouri. Making pseudoephedrine products rx only will solve the problem better than anything else that is out there. Communities that have made it rx only have seen a decrease in meth. I know this to be true from experience. I am a 30 year veteran pharmacist and have seen first hand what making pseudoephedrine rx only does to everyone. People who need the products for legitimate uses have no problems getting an rx from their doctor. Meth makers will have a harder time getting the product if its rx only. These are real facts. i would love to see the full results of this survey to see who they surveyed, where they surveyed, and what questions were asked.
Supervalu reorganizes independent business unit
EDEN PRAIRIE, Minn. — Supervalu on Thursday reorganized its operations in an effort to streamline the independent business organization. As part of the new structure, Supervalu’s independent business will consolidate from three regions to two regions, forming new East and West teams. The new East and West independent business regions will be located in Mechanicsville, Va., and Hopkins, Minn., respectively.
To lead the new organizations, Supervalu has named Kevin Kemp president of the East region and Bill Chew president of the West region.
With this new independent business organization, Supervalu will reduce operating costs while continuing to drive sales growth with its current and prospective customers. The changes also take into consideration the company’s ongoing commitment to delivering value, service and customer programs and offerings that meet the rapidly changing needs of its independent grocery store customers nationwide.
The reorganization will result in a net workforce reduction of approximately 80 positions.
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