New cholesterol guidelines were released on November 12, 2013 by the American College of Cardiology and the American Heart Association. These guidelines detail how high risk patients will be treated by doctors when they have high cholesterol levels in their blood.
The new guidelines use the best available scientific evidence to identify which patients will benefit most from having their blood cholesterol treated, says Dr. Neil J. Stone, a professor of medicine at Northwestern University Feinberg School of Medicine and the chair of the panel that prepared the guidance document. He says the new guidance varies from previous recommendations in that it does not focus on target levels of low-density lipoprotein cholesterol, also known as LDL or, more commonly, “bad cholesterol.” Instead, it puts more emphasis on defining which groups of patients will probably benefit the most from lowering their LDL. It does, however, keep the same definition for what is an optimal level of LDL. According to the American Heart Association, the optimal level of LDL is less than 100 mg/dL.
The guidelines identify four major groups which the experts believe will benefit the most from drugs called HMG-CoA reductase inhibitors, or statins, which are commonly used to reduce cholesterol. These patients are the ones who they believe will experience the greatest reduction in risk of stroke and heart attacks.
The following groups are those identified as most likely to benefit from drug therapy:
- Patients with cardiovascular disease
- Patients with an LDL equal to or greater than 190 mg/dL
- Patients with Type 2 diabetes between the ages of 40 and 75
- Patients with an estimated 10-year risk of cardiovascular disease of 7.5 percent or greater who are aged 40 to 75 (A tool for calculating 10-year risk is provided in the links below the article.)
The new cholesterol guidelines takes the emphasis off of using blood cholesterol levels as the main determining factor in whether a patient will benefit from drug treatment. Instead, doctors can perform a risk assessment to determine which patients will benefit the most from cholesterol-lowering medications.
Dr. Stone believes the main result of the new recommendations will be that more patients who will actually benefit from medication will receive it, while those who are less likely to benefit will not be given medication quite so often. He also believes that the guidelines may cause some doctors to consider putting their patients on higher doses of statins in order gain more benefit.
The document also puts emphasis on the importance of a “heart-healthy” lifestyle as a means to control blood cholesterol. A healthy lifestyle should be the cornerstone of all guidelines, says Dr. Stone, especially in the very young. Preventing high cholesterol is the best way to keep your heart and blood vessels healthy. However, he says, if someone already has disease, lifestyle changes alone are not likely to help and medication may be required.
The cholesterol guidelines are focused on statins, Stone says, because they work the best. The other drugs have their place – for example, in patients who experience side effects with statins – but, in general, statins are safer and give the best results.
In addition to discussing which patients might benefit the most from statins, the guidelines also made recommendations regarding the intensity of drug therapy. Rather than giving patients the lowest possible dose of statins combined with other cholesterol-lowering drugs, the panel found it was preferable to focus on giving patients a higher dose of statins combined with lifestyle changes.
Stone notes that the guidelines are not against trying to lower LDL. Rather, they emphasize the importance of how you get it lower. The panel believes that statin therapy plus lifestyle modifications are the best means to achieve this goal.
These guidelines are, of course, only meant to be a starting point for doctors, says Stone. Each patient will still need to be evaluated on a case-by-case basis, since some patients who might not fall into one of the four identified major groups may still receive benefit from treatment.
The cholesterol guidelines were put together by a volunteer panel of experts which met in June 2013. Their recommendations were based upon an analysis of the available medical literature. All members were required to disclose any healthcare-related relationships up to one year before the project.
By Nancy Schimelpfening