New Statin Guidelines Released

New guidelines from the American Heart Association and American College of Cardiology eliminate strict LDL cholesterol targets and include stroke risk in determining whether patients should take statins.

New guidelines for when patients should take cholesterol-lowering statins do away with specific LDL cholesterol goals and adjust some of the criteria for deciding whether patients should be prescribed the medications in the first place. The guidelines, put together by the American Heart Association and the American College of Cardiology, were released online on November 12, 2013.

The guidelines call for statin use by patients who have heart disease, whose LDL cholesterol is higher than 190 mg/dL, or who are middle-aged with type 2 diabetes. Patients aged 40 to 75 with an estimated 10-year risk of heart disease or stroke of at least 7.5% are also advised to take statins. (These risks are determined using a calculator that takes into account factors such as age, cholesterol levels, blood pressure, and smoking and diabetes status.)

The previous guidelines, released in 2004, had called for patients to continue taking statins until they reduced their LDL cholesterol to below 70 mg/dL. The abandonment of this requirement may lead some patients who were taking statins strictly to meet an LDL cholesterol target to stop taking them. Including the risk of stroke as well as heart attack in determining whether a patient should take statins, however, means that many new patients will qualify for the medications, in particular women and African-Americans. Overall, it is debatable whether the new guidelines will lead to a net increase or decrease in the number of patients taking statins.

Some critics have argued that the committee responsible for developing the guidelines did not take into account studies that back up the benefits of low LDL cholesterol levels and expressed concern that eliminating these goals will undermine patients’ motivation to control their cholesterol. Committee members have countered that large clinical trials have shown that statins reduce the risk of heart attack and stroke but have found no evidence that meeting specific cholesterol goals offers an added benefit.

Other critics have argued that the new guidelines could lead to overtreatment with statins when other measures, such as lifestyle changes, would be more appropriate. For instance, an older patient with low LDL cholesterol who smokes and has moderately elevated blood pressure might qualify for statins based on the guidelines, but would be better off quitting smoking.

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