New Cholesterol Statin Drug Guidelines

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On November 12, 2013 the American Heart Association, in conjunction with the America College of Cardiology, released new guidelines for the treatment of high blood cholesterol. The likely result will be a dramatic increase in the number of Americans taking statin medications to lower cholesterol and heart disease risk. Some in the medical community view this as a positive development while others are opposed. That leaves many with high cholesterol wondering if they should continue to take a statin, or if they should begin taking one. Of course, whether you should continue or start taking a statin is a decision to be made with your personal doctor, but gaining familiarity with the new guidelines will enable a more informed discussion with your medical provider.

What Are The New Cholesterol Medication Guidelines?

Broadly, the new guidelines to determine whether a person with high cholesterol should take a statin work not by looking at a person’s cholesterol numbers, per se, but rather by calculating risk. Specifically, statins are now recommended for anyone at significant risk of developing Atherosclerotic Cardiovascular Disease or ASCVD (basically, heart disease) in the next ten years.

There are four groups of people who the new guidelines define as at risk for ASCVD and thus should take statins: a) those who already have cardiovascular disease; b) anyone with LDL (bad) cholesterol of 190 mg/dL or higher; c) anyone between 40 and 75 years of age who has Type 2 diabetes; and 4) people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher.

How Can I Calculate My 10-Year ASCVD Risk To Know If I Should Take A Statin?

A new online calculator is available as a downloadable Excel spreadsheet on the American Heart Association’s 2013 Prevention Guidelines Tools CV Risk Calculator page – just click the red ‘download CV risk calculator,’ save to your computer and fill in the numbers – you need your Total Cholesterol, HDL (good) cholesterol and Systolic Blood Pressure to fill out the form. The result will be an estimate of 10-year heart disease risk: if it’s greater than 7.5 percent, then statins are recommended. Note that the risk calculator does not apply (can’t be used) if you already have heart disease.

What If I Already Take A Statin – How Can I Calculate My Risk To Know If I Should Continue Taking A Statin?

The new guidelines and online calculator only work if you have a baseline cholesterol level: meaning, you need to know your cholesterol levels without the statin medication. Anyone currently taking a statin who isn’t sure they should continue should discuss going off the statin with their doctor to get a baseline level. Some may recommend that, others likely won’t – but it is a discussion many might want to have with their physician. And of course, you should never stop taking any medication without first discussing it with your doctor.

How Are These New Guidelines Different From The Old Guidelines?

There are two big differences between these new guidelines and the guidelines that had been in place for years. First, the new guidelines are focused on identifying and then reducing the risk of stroke and heart disease – not just cholesterol. Second, the new guidelines no longer recommend reducing LDL (bad) cholesterol to a specific number. It used to be that there were LDL (bad) cholesterol targets. Now, the focus is not on how low LDL can go but instead, if LDL is high (above 190) without statins OR there are other risk factors as outlined above – to begin statins and reduce heart disease risk.

Are The New Guidelines The Result Of Big Pharmaceutical Companies Trying To Get More People To Take Statin Medication?

Although the likely result will be millions more Americans taking statin drugs than ever before, big pharmaceutical companies will not reap big benefits as the majority of statin medications are now off-patent and generic. In fact, when WebMd directly asked if, “the drug manufacturers had any role in this recommendation,” cholesterol guidelines panel member Dr. Robert Eckel answered, “None, actually.”


The definition of optimal LDL cholesterol levels is unchanged by the new guidelines. That said, those with very high LDL cholesterol (>190 mg/dL) – and the other three groups who are at risk for heart disease – will now be advised to take statins. The goal once on statins is now NOT to lower LDL to a specific level. Instead, the goal of the new guidelines is to identify the four at-risk groups (as defined above) and get them started on statins.

Essentially, the point of the new guidelines, according to Neil J. Stone, MD, Bonow professor of medicine at Northwestern University Feinberg School of Medicine and chair of the expert panel that wrote the new guideline, is to focus “on defining groups for whom LDL lowering is proven to be most beneficial.”


These new guidelines may also change the medication prescribed to lower cholesterol. Under the old guidelines (where the goal was to get to a specific (low) LDL cholesterol number) it was common for doctors to prescribe either multiple statins or statins plus other medications to lower LDL as much as possible. Under the new guidelines, doctors may well recommend focus on a healthy lifestyle along with a higher dose of statins, and eliminate the need for additional (cholesterol-lowering) medications. If you take more than one statin or a statin plus another cholesterol-lowering medication you might want to talk with your doctor about a possible medication change.


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