2013 revised guidelines for Cholesterol
(specifically the use of statins)
In November/ December 2013 the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for the prevention and post treatment of strokes and heart disease. These new guidelines are far reaching and change the landscape “to avoid heart disease and stroke by prescribing drugs called statins for some, treating obesity as a disease, and other resources to stay healthy” (American Heart Association, 2013). The new guidelines are a radical shift in policy reflecting additional research and a better of understanding of the issues involved (Williams, 2014). The new standards of treatment are offer a more patient centered approach than previous guidelines issued by the AHA and ACA (Williams, 2014).
The guidelines focus on four major areas and actually changes the basic discussion of the use of statins for some diabetic patients, while at the same time giving doctors more leeway in ethically prescribing statins for others (American Heart Association, 2013; Williams, 2014). Here is a summary of the guidelines:
The new approach is to assess the overall basic health of the patient being prescribed statins. This includes four general areas:
“Cholesterol, Lifestyle, Obesity, and Risk Assessment”
(American Heart Association, 2013).
The new guidelines recommend statin use for people who fall under the following criteria:
1. “People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years.
2. People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
3. People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
4. People with Type 1 or Type 2 diabetes who are 40 to 75 years old”
("Doctor discussion is key for cholesterol treatment," 2014)
This is a major change from guidelines with hard and fixed rules about the use of statins. According to Craig Williams “Medications offer tremendous benefits, but those benefits have limits” (2014). Superficially using a more flexible as opposed to a fixed limit setting may have a direct benefit in how medications are prescribed and to who they are prescribed (Williams, 2014).
For instance under the older guidelines it was always assumed that lower bad cholesterol (LDL) and higher good cholesterol (HDL) was better (Williams, 2014). But if the bad cholesterol is well controlled there may not be much benefit to raising good cholesterol simply for the sake of raising it (Williams, 2014).
This statement hit me very hard, since my LDL (up until February at least) had always been in an exceptional range but my HDL was always a tick below standard. The Cardiologist had threatened several times to increase my statin load in order to raise the HDL. I was not opposed necessarily, but come on doctor HDL is 39 and you want 40 and you want to raise the amount of statin dosage to achieve one more point? I mean maybe we are as close as we need to be. It had been an ongoing debate as my HDL would fluctuate between 35 and 39. While the LDL stayed in exceptional range.
I believe such discussions will continue but on a different field. Clearly under the new guidelines individual Doctors are to be the arbiters of how they want their patents cholesterol readings to balance out. But no longer should the number be the sole and only determinate.
The AHA and ACA estimate that roughly 33 million Americans currently take statins. Some sources suggest that as many as 100 million Americans (or roughly 1/3) might benefit from using statins. A number of these additions are obese people who do not currently take them, most type 2’s, ages 40 to 75 and almost all former heart and stroke patients who do not currently take statins. Notice the group not included, type 1 and 2’s less than 45 years of age. This group has routinely been placed on statins as a preventative measure. Absent other risk factors, these patients may not directly benefit from stain therapy. Of course no one should remove themselves from statin therapy except under the advice of their personal physician. Statin therapy withdraw can have detrimental side effects unless it is done properly. Remember Statins are big drugs. Yes most are now generic and cost very little but do not be lulled into believing that you can simply stop taking the medication. As I told my Cardiologist as she was fretting over my most recent numbers, (something I am fretting over as well) I am not comfortable reducing the drug, but unless there is a reason to increase it, I am not comfortable raising it either.
I have not seen her since my largest upshot ever in LDL. I will see her in August and we will renew the discussion, get new testing and see if the uptick is the drug reaction (the offending drug now removed) that I believe it is. If it is, we will come to a detente’ over more statin use. If not, well her point will be well taken. While I hate taking pills if the February result was not a mere blip on the radar screen, well I can expect more and more powerful prescriptions will be written. Frankly if it this large, I will need them.
American Heart Association. (2013). Understanding the New Prevention Guidelines. Retrieved March 25, 2014, from
Doctor discussion is key for cholesterol treatment. (2014). Explanation of the new heart disease and stroke prevention guidelines, (3 of 5)
Retrieved March 25, 2014, from http://blog.heart.org/doctor-discussion-is-key-for-cholesterol-treatment/
Williams, Craig. Patients are the Guidelines. Diabetes Forecast, April 2014.