It has been a common recommendation from your doctor to get a yearly cholesterol level. This is to determine your risk for heart disease, which is the number #1 killer of men and women in the U.S. But now these recommendations are taking a new approach. According to the American College of Cardiology/American Heart Association, treating high cholesterol numbers for everyone is no longer recommended.
We as practitioners get focused on the LDL part of the total cholesterol number. An elevated low density lipoprotein (LDL) has largely been associated with heart disease. Notice how I said “associated” and not “causes heart disease”. It is as much of a risk factor as high blood pressure, diabetes or smoking. The reason for abandoning the treatment of LDL cholesterol is that research trials showing benefits of using statins have been based on fixed dose statin therapy, rather than doses that were titrated individually for each patient. Everyone was on the same high doses of statins.
Also and more importantly, some drugs that improve your LDL “numbers” don’t necessarily prevent heart attack or stroke. In other words, there are plenty of people lined up at the Emergency Room with heart attacks that have very normal LDL and total cholesterol levels whether they are on statin drugs or not.
So now what…
There are 4 major high risk groups that have shown benefit from initiating statin therapy.
1. Patients with clinical atherosclerotic cardiovascular disease should get moderate or high-intensity statin therapy. This can be determined through a heart scan where plaque is visualized.
2. Patients with LDL cholesterol levels over 190mg/dL (normal levels should be less than 100).
3. Diabetic patients between age 40-75 with LDL cholesterol levels of 70-189mg/dL.
4. Patients without clinical arteriosclerotic cardiovascular disease or diabetes, but with an LDL cholesterol between 70-189mg/dL and an estimated 10-year arteriosclerotic risk > 7.5% should receive statin therapy. There is a downloadable estimated 10-year and lifetime risk web-based calculator on the American Heart Association website at http://my.americanheart.org/cvriskcalculator.
So it looks like putting statins in the drinking water for everyone is not such a good idea. The side effect profile of statins (headache, muscle aches and weakness, difficulty sleeping, drowsiness, dizziness, memory loss, mental confusion, risk of hypothyroidism, rash, abdominal pain) needs to be looked at carefully to determine whether the benefits outweigh those risks.
Lifestyle modification is still the best medicine!
Reference: Stone NJ et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013 Nov 12; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.jacc.2013.11.002)