Guidelines could increase cholesterol drug usage

By Matt Daray

 

More Americans could end up taking cholesterol-lowering statin drugs thanks to new guidelines issued Nov. 12 by national health officials.

The American Heart Association and American College of Cardiology changed their policies to look at more factors other than cholesterol levels when evaluating patients for medication; a change that is controversial among cardiologists. Some experts think the new system is more efficient and is a starting point for Americans to become healthier. The system better informs the country about who needs to worry about cholesterol.

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The new guidelines recommend treatment for patients who have heart disease, Type 2 diabetes, Low-Density Lipoprotein, or LDL cholesterol, over 190 milligrams per deciliter or a 10-year risk of a heart attack above 7.5 percent—factoring in variables such as age, gender, race and if the individual smokes. The guidelines can be entered into a health calculator featured on the AHA’s website.

Dr. Neil Stone, chair of the panel that created the cholesterol guidelines for the AHA, and a professor of medicine at Northwestern University said in an interview, the idea behind the new guidelines started several years ago and are intended to give Americans the best options for their health.

“We were asked by the (National Heart, Lung, and Blood Institute) a number of years ago to review the evidence and try to align the new guidelines, the updated guidelines, more with the evidence,” he said. “Over time, the evidence changes and Americans want their guidelines to reflect not just the latest information but the best.”

Stone said the new guidelines aim to tackle obesity in the country head-on and promote healthy lifestyle changes for people. He said every health guideline changes on a regular basis but this policy had a longer interval than most because the process of revising it is strictly evidence-based. This minimizes individual biases for each case, he said.

The new guidelines also aim to help the people who really need them. Nearly 30 percent of Americans who take statin drugs don’t need them, Stone said.

“Our guidelines, we estimate, would put 32 million on the statin because unlike the old guidelines, we’re trying to prevent heart attack and stroke, and unlike the old guidelines, we have new, better information that says who would benefit and who wouldn’t,” he said.

Dr. Jeremy Davis, an assistant professor of animal science food and nutrition at SIU, said cholesterol is something all animals have and is an important for animals and humans alike.

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“Cholesterol is something in all your cells. We make it, we get it from our diet and basically anything that’s animal-based food is going to (have it),” he said. “Cholesterol is basically in every cell of an animal origin.”

Davis said cholesterol is important to monitor because if it isn’t metabolized, it can accumulate in the body and can become oxidized and damaging. He said this process then leads to hardening of the arteries, causing heart attacks and strokes.

Dr. Firas Al Badarin, a cardiologist for Southern Illinois Healthcare, said the new system shares similarities with the older one, particularly when it comes to lifestyle choices.

“What’s common between the new and the old guidelines is the emphasis on lifestyle. That’s the fundamental of heart disease prevention and this has not changed,” he said.

Core lifestyle choices, like weight reduction, physical activity, avoiding smoking, and avoiding high fat and carbohydrate diets, are still the same as before, Al Badarin said. He said the emphasis on healthy lifestyle would probably always be a factor in the guidelines.

While he can’t debate whether the new system is better than the old one, some of his colleagues across the nation are doing just that, Al Badarin said.

“I don’t think we can say if they are better, worse, or the same and, interestingly enough, they have sparked enormous and intense debates between top leaders in the field,” he said. “So some still advocate, more or less, a modification of the older approach and, obviously, there are strong proponents for the new approach.”

As of Tuesday, some cardiologists across the country from hospitals such as Brigham and Women’s Hospital in Boston tested the new calculator and found that it greatly overestimates the risk of cardiovascular disease.

The new system might not be perfect at the moment, but it is a stepping-stone for better guidelines in the future, Davis said.

“I’m sure that someone is going to critique any changes to recommendations that any of these agencies make but I think it takes time to really work these things out and I think it’s a step in the right direction,” he said.”

Matt Daray can be reached at [email protected] 

or 536-3311 ext. 254.

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