Do you know someone turning 40 this year? Or having an older-than-40 birthday? The American College of Cardiology and the American Heart Association recommend a most unusual but perfect gift. Statins. These medications help lower cholesterol, and if their new guidelines are implemented, it is estimated that about 57 percent of us would be candidates for these drugs. That is a whopping 56 million Americans.

Nothing says “Happy Birthday” to middle-agers like a bottle of statin pills.

Statins and high cholesterol, what do you know? T or F?

1. They are also used to treat high blood pressure.

2. They are a newer class of cholesterol drugs.

3. About 1 in 4 twenty-somethings have high cholesterol.

Last year the ACC and the AHA updated their recommendations for statin use. They recommended more stringent parameters to trigger the prescribing of statins. Using these guidelines, researchers determined just how many Americans would be affected. Their findings are stunning. More than 57 percent of us over age 40 would qualify for statin medications. For the makers of statins this is great news. For physicians and patients, this is a call for more aggressive screening for and treatment of high cholesterol with statins.

How did we get here?

First, let’s talk cholesterol. Cholesterol is found in all body cells. It is necessary for the body to manufacture vitamin D, hormones and substances that help digest food. The liver manufactures more than 70 percent of the body's cholesterol. The normal body makes all the cholesterol it needs but our genetics and diet conspire to provide more cholesterol than is healthy. The excess cholesterol is deposited in our tissues and blood vessels leading to atherosclerotic cardiovascular disease, our number one cause of death. So important is our understanding of cholesterol and ASCVD that 13 Nobel prizes have been awarded to scientists whose primary focus was cholesterol research.

There are a few types of cholesterol, some good and some bad. LDL, or bad cholesterol can accumulate in blood vessels, forming artery clogging plaques and increasing risk for stroke or heart attack. Lowering LDL cholesterol levels is the focus of the ACC/AHA recommendations. Statins lower LDL cholesterol levels and therefore risk of ASCVD. Lovastatin (Mevacor) was the first clinically available statin, hitting the market in 1987. Even before the new guidelines, statins were among the most commonly prescribed medications.

The ACC and AHA has identified 4 groups for statin therapy, and here is their message. If you are 40 years or older you should know your cholesterol levels. Statin therapy is recommended for the following groups: those with known ASCVD (angina, heart attack, stroke, vascular disease) regardless of LDL cholesterol level; those with LDL cholesterol level over 190mg/dL, even if there is no ASCVD; those with type II diabetes and LDL cholesterol over 70mg/dL, even if there is no ASCVD; those with a calculated 10-year risk of cardiovascular disease of 7.5 percent or higher and LDL cholesterol level between 70 mg/dL and 189 mg/dL. Your physician can calculate your 10-year risk of ASCVD and discuss whether you are a candidate for statin therapy.

Birthdays are happy occasions. They may be marked by large celebrations or quiet reflections. Funny hats, noisemakers, birthday cakes, candles, well-wishers and presents. Maybe even a package containing a bottle of statin pills. It just may bring the gift or more birthdays.

Answers: 1. F; 2. F; 3. T.

Dr. Lori Boyajian-O’Neill can be contacted at