New guidelines on who should take powerful cholesterol- lowering drugs will stress treating the sickest and those at the highest risk of a heart attack or stroke, as opposed to the current, more general emphasis on lowering cholesterol numbers. The changes may mean some people can skip taking the drugs, while others may be put on higher doses.
The American Heart Association and the American College of Cardiology teamed up to write the guidelines, released Tuesday in their two medical journals. They urge doctors to look at who’s most at risk of a heart attack or stroke and to treat them intensively. They also steer doctors away, just a bit, from non-statin drugs.
“We really focus on those most likely to benefit," says Dr. Neil Stone of Northwestern University, who chaired the committee that wrote the new guidelines.
What’s important is to get people treated, said Dr. Lori Mosca of NewYork-Presbyterian Hospital, and the Columbia Center for Heart Disease Prevention.
“We are less concerned about the destination and more concerned about getting people on the trains and out of the station,” Mosca told NBC News. “Most patients, when we try to treat their cholesterol, don’t get to the goal. There’s a tendency for physicians to throw their arms up and give up.”
The new guidelines may make it easier to just focus on getting patients started on treatment and benefiting at least a little, Mosca said.
Statins – drugs such as Lipitor, Mevacor, Crestor and Zocor – are extremely popular. They’re prescribed to about a 15 percent of U.S. adults, at a cost ranging from about $11 for the cheapest generic version to $200 for a pricey name-brand.
They’re very good at reducing the risk of heart attacks and strokes, but they are not without side-effects. They can damage muscle in 10-15 percent of patients. In 2012, the Food and Drug Administration updated labeling on statins to include warnings about confusion and memory loss, elevated blood sugar leading to Type 2 diabetes, and muscle weakness.
Previous guidelines focused on numbers. People were supposed to aim for a total cholesterol level of less than 200, keeping low density lipoprotein (LDL or “bad” cholesterol) to 130 for average people and under 100 for those considered at risk of a heart attack. People at the highest risk, like heart attack survivors, were supposed to keep LDL to 70 or below.
The new guidelines stress simply getting people started on the right dose of statins, rather than aiming for a particular cholesterol level.
Under the new guidelines, more than 30 percent of U.S. adults may qualify for statin treatment, says Dr. Donald Lloyd-Jones, also at Northwestern, who co-chaired the panel. ”It’s about twice as many adults who will be eligible for ‘definite treat’ status,” he said.
“We were not concerned with treating more or less people. We were concerned with treating the people who would benefit most,” Stone added.
These include people who already have heart diseases, people whose LDL is 190 or higher, people with type-2 diabetes who are aged 40 to 75, and others with a calculated high risk of heart disease.
“Whereas in the old guidelines, all diabetics would be treated, this review of the evidence reveals some younger diabetics might not need statins,” Stone said.
“Statins were chosen because their use has resulted in the greatest benefit and the lowest rates of safety issues. No other cholesterol-lowering drug is as effective as statins,” Stone added.
“Many more people are going to be treated with statins as a result of these guidelines, that’s the good news but bad news is more people will experience side-effects,” cautioned Dr. Carl Orringer, a cardiologist at University Hospitals Case Medical Center in Cleveland, who was not involved in setting the guidelines.
Separately, the American Heart Association and the American College of Cardiology said doctors should also give every patient specific instructions on how they should eat and exercise to reduce heart risk. They include eating four to five servings of fruit every day, another 4-5 servings of vegetables, eating whole grains and limiting meat, fish and poultry to 6 ounces or less a day.
They also advise moderate- to vigorous-intensity aerobic exercise, such as brisk walking, for an average of 40 minutes three to four times a week.
Judy Silverman contributed to this article