New Guideline for
Management of Blood Cholesterol: Focuses On Lifestyle, Statin Therapy for
Patients Who Most Benefit
The
American College of Cardiology and the American Heart Association today
released a new clinical practice guideline for the treatment of blood
cholesterol in people at high risk for cardiovascular diseases caused by
atherosclerosis, or hardening and narrowing of the arteries, that can lead to
heart attack, stroke or death.
The
guideline identifies four major groups of patients for whom
cholesterol-lowering HMG-CoA reductase inhibitors, or statins, have the
greatest chance of preventing stroke and heart attacks. The guideline also
emphasizes the importance of adopting a heart-healthy lifestyle to prevent and
control high blood cholesterol.
"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."
The
new guideline recommends 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).
In
terms of clinical practice, physicians can use risk assessment tools in some
cases to determine which patients would most likely benefit from statin
therapy, rather than focusing only on blood cholesterol to determine which
patients would benefit.
"The
likely impact of the recommendations is that more people who would benefit from
statins are going to be on them, while fewer people who wouldn't benefit from
statins are going to be on them," Dr. Stone said. Doctors may also
consider switching some patients to a higher dose of statins to derive greater
benefit as a result of the new guidelines.
The
guideline was prepared by a panel of experts based on an analysis of the
results of randomized controlled trials. The panel was charged with guiding the
optimal treatment of blood cholesterol to address the rising rate of cardiovascular
disease, currently the leading cause of death and disability in the U.S.
The
panel chose to focus on the use of statins after a detailed review of other
cholesterol-lowering drugs. "Statins were chosen because their use has
resulted in the greatest benefit and the lowest rates of safety issues. No
other cholesterol-lowering drug is as effective as statins," said Dr.
Stone. He added that there is a role for other cholesterol-lowering drugs, for
example, in patients who suffer side effects from statins.
The
report also stresses the importance of lifestyle in managing cholesterol and
preventing heart disease. "The cornerstone of all guidelines dealing with
cholesterol is a healthy lifestyle," said Dr. Stone. "That is
particularly important in the young, because preventing high cholesterol later
in life is the first and best thing someone can do to remain heart-healthy. On
the other hand, if someone already has atherosclerosis, lifestyle changes alone
are not likely to be enough to prevent heart attack, stroke, and death, and
statin therapy will be necessary."
In
addition to identifying patients most likely to benefit from statins, the
guideline outlines the recommended intensity of statin therapy for different
patient groups. Rather than use a "lowest is best" approach that
combines a low dose of a statin drug along with several other
cholesterol-lowering drugs, the panel found that it can be preferable to focus
instead on a healthy lifestyle along with a higher dose of statins, eliminating
the need for additional medications.
"The
focus for years has been on getting the LDL low," said Dr. Stone.
"Our guidelines are not against that. We're simply saying how you get the
LDL low is important. Considering all the possible treatments, we recommend a
heart-healthy lifestyle and statin therapy for the best chance of reducing your
risk of stroke or heart attack in the next 10 years."
The
guidelines are intended to serve as a starting point for clinicians. Some
patients who do not fall into the four major categories may also benefit from
statin therapy, a decision that will need to be made on a case-by-case basis.
The
expert panel that wrote the report was convened by the National Heart, Lung,
and Blood Institute of the National Institutes of Health. At the invitation of
the NHLBI, the American Heart Association and American College of Cardiology
assumed the joint governance, management and publication of this guideline,
along with four other prevention guidelines, in June. Committee members
volunteered their time and were required to disclose all healthcare-related
relationships, including those existing one year before the initiation of the
writing project.
The
full text of the report, "2013 ACC/AHA Guideline on the Treatment of Blood
Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults," will
be published in future print issues of the of the Journal of the
American College of Cardiology and the American Heart Association's
journal Circulation. It will also be accessible on the ACC (http://content.onlinejacc.org/article.aspx?doi=10.1016/j.jacc.2013.11.002)
website and AHA (http://circ.ahajournals.org/lookup/doi/10.1161/01.cir.0000437738.63853.7a).
Story Source:
The
above story is based on materials provided by American College of Cardiology.
Note: Materials may be edited for content and length. For further
information, please contact the source cited above.
Journal Reference:
1.
Stone NJ, Robinson J,
Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the Treatment of
Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Journal
of the American College of Cardiology, 2013; DOI:10.1016/j.jacc.2013.11.002
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American College of Cardiology (2013, November 12). New guideline
for management of blood cholesterol: Focuses on lifestyle, statin therapy for
patients who most benefit. Science Daily. Retrieved November 13,
2013, from http://www.sciencedaily.com/releases/2013/11/131112163210.htm