Monday, November 18, 2013

A Closer Look at the New Cholesterol Guidelines

by Dr Ron Sinha

New Cholesterol Guideline Theme: It’s All About Your Heart Attack Risk

The main recommendation from the guidelines is that individuals who fall into any of the following four categories should be on a statin:
1. Those with existing heart disease
2. Those with LDL levels above 190 mg/dl
3. Those with diabetes aged 40 to 75 years with LDL between 70-189 mg/dL and without existing heart disease
4.  Those without heart disease or diabetes, with an LDL between 70-189 mg/dL and an estimated 10-year heart attack risk of above 7.5%
When comparing the old guidelines to this one, the first 3 categories are essentially unchanged.  Most doctors would put heart disease patients, diabetics and those with LDLs above 190 mg/dl on statins.  There are some advantages to the newer guidelines:
  • The focus of therapy is on statins, which are the default drug of choice.  This is a good thing for those who truly need statins and should hopefully avoid cumulative toxicity from multiple drugs.
  • The concept of treating to a specific LDL target number has been eliminated.  This is good since it should reduce unnecessary high dose statin therapy to reach low targets which have not been proven to reduce heart attack risk.
  • These guidelines do a better job of highlighting statin adverse side effects which will hopefully make clinicians think twice before pulling the statin trigger
  • Greater overall emphasis on heart attack risk rather than a focus on the LDL number which makes more sense.

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