Cholesterol Guideline Changes

A whopping 13 million more Americans will now be taking statins due to the recent changes in the guidelines formulated by the American Heart Association and the American College of Cardiology (source:  NEJM).  The new guidelines released by the American Heart Association were released back last November.  

The new guidelines are taking a very different approach.  Rather than focusing on specific end targets for cholesterol, the guidelines focus more on risk and prevention of strokes and heart attacks.  They disregard the guideline that doctors should prescribe cholesterol-lowering drugs when a patient's LDL, or bad cholesterol, reaches a certain threshold — in recent years, above 130.  The guidelines also say everyone with known heart disease should be taking statins.

The guideline recommends statin therapy for the following groups:

  • 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.  (According to a new risk calculator).
  • 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).
  • People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
  • People with Type 1 or Type 2 diabetes who are 40 to 75 years old.  The drugs are also recommended for younger adults if their LDL cholesterol is over 190.

(Just for reference the old guidelines, using a different calculator, prescribed statin use at a 10-year risk above 20 percent, along with an LDL-cholesterol reading above 130).

As far as side effects go:

BCPS COPD: The Gold Guidelines (2013)

PPIs and C. Diff