New Cholesterol Guidelines

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This week, the new guidelines on preventing heart disease were released by the American Heart Association and the American College of Cardiology.  The media reported widely about this.  Now, for most people, monitoring LDL-cholesterol and total cholesterol levels is not indicated.  If your risk of developing cardiac disease is over 7.5% over a ten year period, then statins are recommended. The risk can be calculated by going to the American Heart Association website (www.heart.org) and plugging in your cholesterol and HDL-cholesterol numbers  as well as your age and whether you smoke or not.  Then a number is revealed.

It is hard for me to believe that this is where modern medicine is at.  I guess nobody needs to see a health care professional anymore—just put your numbers in and if you have a 10-year heart attack risk of >7.5%,then you must take a statin for the rest of your life.  I have one word for this nonsense:  fugetaboutit.

The new guidelines are contained in an 85 page, mind-numbing document.  It is a very difficult manuscript to read.   I will take pieces of it and share my concerns with you.  Let’s start with the recommendations that would put most adult Americans on statin drugs.  On page 18, the report states, “Data has shown that statins used for primary prevention have substantial ASCVD (atherosclerotic cardiovascular disease) risk reduction benefits across the range of LDL–C levels of 70-189 mg/dL.”  Of course, that is after the “experts” state that it is unclear of lowering LDL-cholesterol levels have any benefit.  Nonetheless, the authors cite a meta-analysis by the Cholesterol Treatment Trialists’ (CTT) to support their conclusion. (1)

The CTT article was a meta-analysis of 27 randomized trials to ascertain whether reducing LDL-cholesterol levels with statin use reduces vascular events in people who are at a low risk for cardiac events.   The authors of the article reported that reduction in LDL-cholesterol levels with a statin reduced the risk of major vascular events by 21%.    However, this is a relative risk reduction.  When deciding whether to prescribe a statin for a patient, the 21% relative risk reduction should not be used.  Unfortunately, most (or nearly all) doctors have absolutely no understanding about statistics and what relative risk means.

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