This post was authored by Henry H. Ting, MD, MBA, FACC, professor of medicine at Mayo Clinic in Rochester, MN.

In 2013, ACC and American Heart Association issued new cholesterol guidelines, replacing previous guidelines that had been in place for more than a decade. The new guidelines are a major advance and include: (1) using an online calculator to estimate 10-year risk of heart attack or stroke; (2) changing the treatment goal from an approach of “treat to target LDL”  to that of “treat to risk”; and (3) recommending statins as a drug class with proven efficacy to lower cardiovascular risk, and not just to lower LDL. A controversial aspect of the new guidelines is the recommendation to prescribe statins to healthy patients if their 10-year cardiovascular risk is ≥7.5 percent.

Clinicians and patients should use shared decision making tools to select individualized treatments based on the new guidelines to prevent cardiovascular disease, according to a viewpoint paper published in this week’s Journal of the American Medical Association, of which I am a co-author. Shared decision making is a collaborative process that allows patients and their clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, preferences, and context.

Rather than routinely prescribing statins to the millions of adults who have ≥7.5 percent risk of having a heart attack or stroke within 10 years, there is an opportunity for clinicians and patients to discuss the potential benefits, harm and burdens of statins in order to arrive at a choice that reflects the existing research and the values and context of each patient. For instance, if a patient has a 10-year cardiovascular risk of 8 percent, then taking statins for a decade will lower his/her risk to 6 percent – in natural frequencies, that means for every 100 patients with comparable risk who agree and adhere to statins for a decade, 2 patients will avoid a heart attack or stroke, 6 will still have a heart attack or stroke, and 92 will not have a heart attack or stroke regardless if they took a statin (Figure 1). Since patients have unique values, preferences, and contexts, some patients with a risk of 10 percent may decide not to take statins for a decade as the potential benefit does not outweigh the risks and work required for adherence; whereas other patients with a risk of 6 percent may decide to take statins for a decade as the potential benefit does outweigh the risks and work required for adherence.

Visit CardioSource.org/Prevention for additional expert commentary, tools and resources on the prevention guidelines.

Figure 1:

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