The nation’s newest guidelines in almost a decade for prevention of heart disease and high cholesterol were released Tuesday by the American Heart Association and American College of Cardiology.
The guidelines identify four groups of patients who can reduce their risks of cardiovascular problems by taking cholesterol-lowering HMG-CoA reductase inhibitors, also known as statin drugs.
Dr. Neal Stone, chair of the expert panel that wrote the new guidelines, said in a press release that the recommendations target a specific sector of people.
“The new guideline uses the highest quality scientific evidence to focus treatment of blood cholesterol on those likely to benefit most,” said Stone, Bonow professor of medicine at Northwestern University Feinberg School of Medicine.
“This guideline represents a departure from previous guidelines because it doesn’t focus on specific target levels of low-density lipoprotein cholesterol, commonly known as LDL, or ‘bad cholesterol,’ although the definition of optimal LDL cholesterol has not changed. Instead, it focuses on defining groups for whom LDL lowering is proven to be most beneficial.”
Current guidelines determine a person’s total cholesterol should be under 200, and LDL under 100. People with high cholesterol are at high risk for cardiovascular diseases caused by atherosclerosis (hardening and narrowing of the arteries), which can lead to heart disease or stroke, the No. 1 and No. 4 leading causes of death in the United States.
The new guidelines recommend moderate- or high-intensity statin therapy for these four groups:
- Patients who have cardiovascular disease;
- Patients with an LDL, or “bad” cholesterol level of 190 mg/dL or higher;
- Patients with Type 2 diabetes who are between 40 and 75 years of age; and
- Patients with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years of age. (The report provides formulas for calculating 10-year risk.)
The last guideline for the treatment of cholesterol was published in September 2002 and updated in 2004.
A new set of recommendations were needed given the nature of the previous ones, David Winchester, assistant professor of medicine at the University Of Florida College Of Medicine, said.
“The prior guidelines depended a fair amount on the opinions of the people that were writing the guidelines, which is to say that these are people who are experts in the field and they had evidence to support their recommendations,” he said. “But in areas where the evidence wasn’t directly applicable, they sort of used their expertise to say this is what ought to be done for these sorts of patients.”
The new threshold could double the number of Americans taking statins to about 70 million.
“With these guidelines, the strategy has shifted,” Winchester said. “The focus was really on what can we absolutely and unequivocally say with the strongest evidence that we have and try to scale back how much of this is based on our opinions.”
Other drugs used to treat high cholesterol are fibrates, niacin and fish oil.
Evidence in the past has proved these drugs are effective, but the latest studies show a greater reduction in heart attacks and deaths that are linked to the statin drugs more so than other treatment therapy.
Winchester said some in the medical field have known of the benefits of statins for years.
“These guidelines summarize the evidence we knew existed, but we can see those studies (now),” he said. “We wanted to make sure that we as a community of doctors taking care of people were seeing the same signals and that we were moving in the same direction toward treatment and prevention of heart disease.
“The focus of the guidelines has shifted from let’s lower the cholesterol any way we can to let’s make sure people are on these statin drugs that have proven benefits of reducing heart attacks and reducing deaths,” Winchester said.
While the increase of statin therapy could help millions, simply relying on medication is not enough, Dr. William Zoghbi, immediate past president of the American College of Cardiology, said.
“We cannot forget the importance of diet, exercise, healthy lifestyle to help in this endeavor,” he said. “That should be No. 1, and we have to kind of keep that in mind.”