The NEW guidelines for cholesterol-lowering statin meds

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It was another big week for cholesterol news.

Last week the FDA declared that partially hydrogenated oils (PHOs), a very common processed food ingredient, are now not safe. As explained in FDA: Trans Fats are not GRAS, if PHOs are indeed declared not GRAS (generally regarded as safe), FDA will have found a way to significantly reduce unhealthy trans fats from the American food supply. Which is huge.

Then this week, more enormous cholesterol news.  On November 12, 2013, the American Heart Association and the America College of Cardiology released new guidelines for the treatment of high blood cholesterol. The new guidelines will very likely result in a dramatic increase in the number of Americans taking statin medications to lower cholesterol and heart disease risk.

Both in the span of just one week

And it wasn’t even National Cholesterol Education Month.  (That was September.)

What gives? Why these two huge announcements now, within days of each other?

While I have no idea if the timing was coordinated (or not), I do know that both moves have the potential to significantly reduce cholesterol and heart disease risk. And that one move (banning PHOs) is a no-brainer while the other (the new statin guidelines) has many up in arms.

As you know, I am not statin-girl (unless clearly warranted) so it’s potentially troubling that the new guidelines will prompt millions of new statin prescriptions. So I empathize with those who are unhappy with the new guidelines. That said, I am all for the RATIONALE behind these new guidelines — which focus on heart disease risk, not on reducing a particular cholesterol number in an otherwise healthy, low-risk individual.

This makes sense to me.

And OK, so I’m not a doctor, so who cares that it makes sense to me? On the other hand, I do think a great deal about medical issues… and to me, these new guidelines are logical. And logical=good, right? In effect, the new guidelines recommend statins only for those AT RISK of heart disease. For those who have high cholesterol but low heart disease risk, statins are NOT recommended.

So, what exactly are the new guidelines? Broadly… if you are in one of the following four groups, you have elevated heart disease risk and should take statins:

  1. those who already have cardiovascular disease
  2. anyone with LDL (bad) cholesterol of 190 mg/dL or higher
  3. anyone between 40 and 75 years of age who has Type 2 diabetes
  4. people between 40 and 75 who have an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher. (And there’s a calculator available online ** so you can figure out if this applies to you. It’s an Excel spreadsheet download – click the red ‘Download CV Risk Calculator’ box and save it to your computer. Do it soon because they may take it down…)** NOTE – the ‘risk calculator’ is occasionally taken down, edited, etc.  If the above link doesn’t work, check my RESOURCES page as I’ll try to keep that one current.

That’s it in a nutshell (well, that and the elimination of the old guideline to get LDL to an ‘as-low-as-possible’ level — in the new guidelines, there is no set LDL goal level).

Is that all? Of course not – there was a ton of media coverage last week, and there’s a lot more in-depth understanding of the guidelines that can be had. As it’s an important (and can be confusing topic), I wanted to provide what I found to be the best primary sources in case you want to dive in and read more.

(If, on the other hand, you prefer to read one piece providing an overview of the new guidelines, how they are different from the old guidelines, and how to calculate your personal heart disease risk, you might find this article I just published on more useful: “New Cholesterol Statin Drug Guidelines.”)

But if you want more in-depth information, here are some sources:

Perhaps the new guidelines will result in millions more Americans taking statin drugs – but perhaps, if they are the RIGHT people to take statins, that will be a good thing.  If you are wondering if you should take a statin, read up on the new guidelines, calculate your heart disease risk online, and talk to your doctor.

If you already take statins (or have heart disease already) the online calculator won’t work for you — in that case, talk to your doctor about what the new guidelines mean for you.  Maybe your doctor will recommend going off statins for a bit to see what your baseline cholesterol level is now. Or maybe your doc will want you to stay on statins, but will switch you to a different one.

Either way, the times have changed. Read up on the new guidelines and talk to your doctor about how they apply to your situation.

I know I will.


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