{"product_id":"paul-d-thompson-cholesterol-treatment-duration-20","title":"Cholesterol treatment: how long to take statins? 20","description":"\u003ch1\u003eHow Long to Take Cholesterol Medication: Lifelong Statins and the Legacy Effect\u003c\/h1\u003e\n\u003ch3\u003eJump To Section\u003c\/h3\u003e\n\u003cul\u003e\n  \u003cli\u003e\u003ca href=\"#lifelong-treatment\"\u003eThe general recommendation: lifelong treatment\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#when-to-stop\"\u003eWhen stopping may be reasonable\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#legacy-effect\"\u003eThe legacy effect in the West of Scotland study\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#older-adults\"\u003eStatins after age 70\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#stroke-prevention\"\u003eWhy stroke prevention matters to older patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#full-transcript\"\u003eFull Transcript\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2 id=\"lifelong-treatment\"\u003eThe general recommendation: lifelong treatment\u003c\/h2\u003e\n\u003cp\u003eHow long to take cholesterol medication is a question patients often ask, Dr. Anton Titov, MD, notes. Cardiologist Dr. Paul D. Thompson, MD, used to answer with a joke about Willard Scott, a Today Show host in the United States who read out the names of people who reached age 100: take it until Willard Scott reads your name. In other words, you are not going to stop.\u003c\/p\u003e\n\u003cp\u003eDr. Thompson says the general recommendation is lifelong treatment with cholesterol medicines to prevent heart attacks and strokes. He adds that the decision is ultimately up to the patient.\u003c\/p\u003e\n\u003ch2 id=\"when-to-stop\"\u003eWhen stopping may be reasonable\u003c\/h2\u003e\n\u003cp\u003eStopping cholesterol medication is an option for some people, in Dr. Thompson's practice. He acknowledges that patients fear taking it for their whole life. He may stop the medicines for some older people who start developing dementia, or who are not afraid of a heart attack or stroke and want to stop. He also sees no need to continue a statin when a person gets cancer or has something else that will limit survival.\u003c\/p\u003e\n\u003cp\u003eStill, he notes that studies show the risk of heart attacks goes up when older people, in their 70s or 80s, stop a statin. His general advice remains to stay on it, while respecting that, as he often says, he does not own the patient's body.\u003c\/p\u003e\n\u003ch2 id=\"legacy-effect\"\u003eThe legacy effect in the West of Scotland study\u003c\/h2\u003e\n\u003cp\u003eThe West of Scotland study is Dr. Thompson's example of benefit that lasts after treatment ends. People received pravastatin or placebo, and those on pravastatin had a lower risk of heart attack or stroke over time. After five years the study was stopped. About 30% of the people stayed on pravastatin, and about 30% of the placebo group went to pravastatin.\u003c\/p\u003e\n\u003cp\u003eOver the next 20 years of follow-up, the curves continued to diverge. Dr. Thompson's interpretation is that people treated for five years had benefit that extended well beyond those five years.\u003c\/p\u003e\n\u003ch2 id=\"older-adults\"\u003eStatins after age 70\u003c\/h2\u003e\n\u003cp\u003eStatin treatment in people over 70 was examined in a recent Australian study that Dr. Thompson describes. He thinks it had 5,000 people in each group. In his account, starting a statin reduced the risk of heart attacks and did not increase the risk of dementia. He therefore generally recommends lifelong statin treatment, unless the patient does not want it.\u003c\/p\u003e\n\u003ch2 id=\"stroke-prevention\"\u003eWhy stroke prevention matters to older patients\u003c\/h2\u003e\n\u003cp\u003eStroke prevention gets particular emphasis from Dr. Thompson. He says many older people worry less about a sudden fatal heart attack than about a stroke that leaves them in a nursing home, unable to eat. He points out that statins prevent most strokes, though not all of them.\u003c\/p\u003e\n\u003ch2 id=\"full-transcript\"\u003eFull Transcript\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Anton Titov, MD:\u003c\/strong\u003e How long to take cholesterol medication, the legacy effect of cholesterol treatment. Patients often ask how long they must take cholesterol medication. In a video on your blog you explained the legacy effect, the lasting benefit of earlier cholesterol treatment. Professor Thompson, how long must a patient take cholesterol medication? When is lifelong cholesterol treatment needed?\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e There used to be a guy on the Today Show here in the United States, and his name was Willard Scott. What Willard Scott would do is, when someone made it to age 100, he would read their name on the Today Show in the morning. So he had all these hundred-year-old people and showed their picture.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Willard has since died, and now nobody knows who the heck Willard Scott was. So when people would ask me years ago how long they should take cholesterol medication, I would tell them, \"Until Willard Scott reads your name on the Today Show.\" In other words, you are not going to stop. We generally recommend lifelong treatment with cholesterol medicines to prevent heart attacks and strokes, but obviously it is up to the patient.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Patients have a fear of taking cholesterol medication their whole life. If someone starts getting dementia or things like that, or they are not afraid of having a heart attack or a stroke and want to stop the medicines as they get older, for some people I will stop the medicines. But generally we recommend that people stay on it.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Now, there are some people who do not want to stay on it. Did they get any benefit from being on it? There is a study called the West of Scotland study, and what they did is they treated people with pravastatin or placebo.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e So I am going to draw; I am going to use my arm. Here are the people that were on the placebo. That is their rate of getting heart disease.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e This is over time, and so over time they had more and more people getting heart disease. Here are the people that got pravastatin, okay? They had a lower risk over time; they had a lower risk of getting a heart attack or stroke.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e After five years the study was stopped, and about 30% of the people stayed on the pravastatin. About 30% of the placebo group went to pravastatin, but what they noticed is that they followed these people over the next 20 years and the curves continued to diverge. So these people were treated for five years, but they had benefit that extended well beyond the five years.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e So I recommend people stay on their statin for as long as they want to live and want to avoid. They get cancer, they have something else that is going to limit their survival. No need to continue the statin.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e You can obviously stop it. So it always depends. There are studies that show that if you stop a statin and you are older, in your 70s or 80s, your risk of heart attacks goes up.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e It goes up. There is also a recent study that was done in Australia. I think there were 5,000 people in each group, and they were all over the age of 70.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e They showed that going on a statin reduced the risk of heart attacks. It did not increase the risk of dementia or any of that sort of stuff. So I generally recommend lifelong statin treatment, except if the patient does not want to do it.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e And as I say all the time, I do not own the body. I think the best thing to not have a heart attack or a stroke is to stay on it. Now, I emphasize stroke a lot, because a lot of older people do not care if they get a heart attack and drop dead, but they do not want to have a stroke and be sitting in the nursing home drooling and unable to eat the oatmeal.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e So strokes are also prevented by statins: most strokes, not all strokes, but most strokes.\u003c\/p\u003e\n","brand":"Diagnostic Detectives Network","offers":[{"title":"Default Title","offer_id":48388695064732,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/2225157989-8a9861c4bcffab1efe24c64c14b65704eee730a0683e5facf124ddf8793bdd23-d_1920x1080_47b3c482-55aa-4b6f-a1ae-b103534b5668.jpg?v=1794435452","url":"https:\/\/diagnosticdetectives.com\/he\/products\/paul-d-thompson-cholesterol-treatment-duration-20","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}