For the new guidelines as I understand it statins for recommended for 4 groups of people:
1. People who already have atherosclerotic cardiovascular disease.
2. People with LDL levels of 190 or above
3. People who are diabetic between the ages of 40 and 75
4. People with none of the above, but ho have LDL between 70 and 189 and a 10 year risk of atherosclerotic cardiovascular disease.
http://www.medscape.com/viewarticle/814152
There is also not a requirement to try get people to a specific low LDL. What I understand from reading is that under the old guidelines they would try to get someone to a specific LDL target. If statins alone didn't achieve it then they would try to add other drugs or increase dosage to try to get there. Basically they now feel that piling on more drugs just to get to a specific LDL number doesn't achieve much. Part of this is because much of the benefits from statins apparently have nothing to do with the cholesterol reducing effects but from other things statins do such as reducing inflammation.
There are some people who would probably be prescribed under the old guidelines, but would not be prescribed under the new ones. I used to take statins (I am one of those relatively rare people who do get a dramatic reduction in cholesterol level from taking statins). It is clear that under the new guidelines I would not be part of the group recommended to take statins, unless there is some additional criteria used.
Basically people who were told to take statins just because their LDL was high wouldn't be told to take stains under this unless the LDL was at least 190 or the other criteria was met.
However, I read that under the old guidelines for people without high LDL, or existing heart disease, the criteria was a 10 year risk of over 20%. That has been lowerd to 7.5%. This is what brings in tons more people.
You can run the calculator for yourself. You have to download the CV risk calculator
Prevention Guidelines
This is an interesting calculator. Using my numbers from the last time I had cholesterol checked my 10 year risk percentage for ASCVD is about 3% (I am 59). Someone my age with optimal risk factors would have a 2.1% risk. Someone at 50 (that is the only age used on their for the lifetime risk part) with optimal risk factors would have a lifetime risk of 8%.
Using my actual numbers from the last check gave me a 3.1% 10 year risk and 39% lifetime risk. The higher lifetime risk is apparently mostly based upon 2 numbers. My overall cholesterol number and the fact I put in 120 as my systolic BP. In reality, when tested the BP number is usually from 118 to 120.
If I lower my overall cholesterol number from 205 to 180 with systolic BP of 120 my lifetime risk goes to 27%. Lowering my systolic BP to 119 does nothing. If I use 175 cholesterol and 120 systolic BP the lifetime risk is 27%. But then lower systolic BP to 119 and the risk goes down to 8%. So the calculator seems to have some very jarring changes.
The big thing is that some people will have a risk of over 7.5% even with optimal risk factor levels. For example, DH is 66. A 66 year old white male with optimal risk factors has 9.6% 10 year ASCVD risk. So this would say that DH should be prescribed statins basically because he is 66 years old and a male (the risk for a 66 year old white female is 4.5% for 10 years).
And, this is where the big increase in people recommended to take statins come from - all the people who due to age (anyone age 71 or older) or gender (white men who are 63 or older) have a greater than 7.5% risk even if all other risk factors calculated are optimal. Most of those people would be nowhere close to the old 20% level.
