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New cholesterol guidelines are out and the bottom line is millions of Americans will be told they should be taking a cholesterol-lowering drug and millions will be told that they can stop. The new guidance comes from the nation's two leading groups of heart specialists. It's a big departure from the advice Americans have been getting for decades to get their cholesterol levels down to a certain number.
As NPR's Richard Knox reports, the new emphasis is on whether you fit into one of four risk groups.
RICHARD KNOX, BYLINE: This big change affects tens of millions of Americans. But Dr. Sidney Smith says new evidence justifies a major course correction.
SIDNEY SMITH: You know, if we're on the Titanic you can rearrange the deck chairs or you can change the direction. I think it's time to change the direction.
KNOX: Smith, at the University of North Carolina, was one of the guideline writers. He says the American College of Cardiology and the American Heart Association have been sifting the evidence for four years to come up with the most up-to-date advice. The result: The number of Americans now advised to start taking a cholesterol-lowering statin drug every day has doubled to about 31 million now.
There's some confusion about those numbers. Some say as many as 30 million Americans are already on statins.
SMITH: I don't know whether that's true or not. But that tells me that there may be a lot of patients taking statins that don't need to take them that may not benefit from them.
KNOX: So tens of millions may be advised to stop taking statins, while equal numbers are urged to start. But Smith says the payoff will be worth it.
SMITH: Overall, I would hope that we would see something in the range of a 20 percent reduction in heart attacks, strokes and premature mortality.
KNOX: And that translates to around a half-million fewer heart attacks, strokes and prevented deaths per year.
So just what do these new guidelines say? Basically, it depends on your risk group. That is, if you've already survived a heart attack or stroke, or are under 75 years old and have diabetes, or have a very high level of LDL - the bad cholesterol - which usually means you're genetically predisposed to clogged arteries. All these people should be taking a high dose of statins, drugs such as Lipitor, Zocor or Crestor, or their generic equivalents. They cost from $4 to $150 a month.
If you're an adult under 75 and don't have any of these risks, your doctor should check your odds of suffering a heart attack or stroke in the next 10 years, using a new risk calculator. If your 10-year risk is seven and a half percent or higher, the guidelines say you should be on a moderate dose of statin.
SMITH: It really boils down to do you have disease? Or do you have one of the factors known to put you at risk for disease, like inherited high cholesterol or diabetes. Or do you have a group of risk factors that put you at risk for having a heart attack in the next 10 years?
KNOX: Smith says the new guidelines should actually make life simpler for doctors and patients because most don't have to worry about starting a statin if their cholesterol reaches a certain point or about getting it down, through drugs, to a specific number target. But others think the new guidelines are more complicated.
DR. STEVEN ATLAS: Much more complex.
KNOX: That's Dr. Steven Atlas, a primary care doctor in Boston, who actually thinks new cholesterol guidelines are overdue.
ATLAS: To move from treating the number to preventing heart attacks is a real big jump. And I think it's going to take a long time and a lot of work to get patients and doctors to move towards.
KNOX: Dr. Steven Nissen at the Cleveland Clinic also thinks the new guidelines are not easy to grasp.
DR. STEVEN NISSEN: I worry significantly about this causing confusion, because we've been telling patients for two decades know your numbers, treat to a target level. We've told the same thing to family doctors.
KNOX: And he worries the new calculator may overestimate a patient's risk. When I tried it out on myself, it said I should be on a statin even though my cholesterol numbers are optimal, I exercise and eat a heart-healthy diet, and my high blood pressure is under control. I asked Nissen what he'd say about that.
NISSEN: If you came to see me, Dick, with those numbers and that history and just a little mild hypertension on treatment, there's not much of a chance I would treat you with a statin.
KNOX: But that's sort of the point. The risk calculator is supposed to get me and my doctor to talk about it and decide if I should get a test, such as one called a CRP that might reveal some underlying reason for concern.
Richard Knox, NPR News
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