New Guidelines on Cholesterol Medications
November 16th, 2013The American Heart Association and the American College of Cardiology recently announced new guidelines outlining who should be on cholesterol medications. Essentially, they are saying more Americans need to be put on “statins”, a class of cholesterol-lowering drugs including brand names such as Crestor, Lipitor, and Zocor. The revised guidelines suggest that health care providers in the US should into consideration the many risk factors that can lead someone to develop ASCVD (atherosclerotic cardiovascular disease) and not just their cholesterol numbers alone. In fact, they suggest most people do not need to have their cholesterol levels rechecked after starting an appropriate dose of statin. In my opinion, this is a tough pill to swallow. Most people would like to see how low their cholesterol drops after starting a medication; it provides them with feedback on how they are doing and encouragement to continue taking the medications.
Another big change is the reduction in the cutoff point where statins should be considered as treatment. Previously, medical providers would calculate a cardiac risk assessment using guidelines outlined by the Framingham Risk Assessment Tool. This takes into consideration risk factors such as high blood pressure, smoking, total cholesterol, and HDL “good” cholesterol. If this number came out with a number over 10% (indicating the patient has a 10% chance of developing ASCVD over the next 10 years), the person should be placed on cholesterol-lowering medications. The recently released guideline suggests this should be lowered to 7.5%. What does this mean for people in the US? More people are going to meet the criteria to start statins sooner.
How will these changes affect medical care? This is still hotly debated, but in my opinion medical providers will be “freed” from focusing on the numbers. Instead they will be able to pay more attention on counseling and realizing that there are other risk factors aside from cholesterol that need to be addressed. For example, if someone is a smoker with high cholesterol merely being on a statin does not reverse the greater damages of smoking.
How will this affect you? No matter how old you are, you should ask your medical provider to do a cardiovascular risk assessment at every annual physical. If you are overweight, smoker, or have high blood pressure, you need to have these under control. These are the major risk factors for ASCVD that you can change with lifestyle modifications or medications. Cholesterol medications should never be a replacement for healthy living.
