The following editorial appeared in the Chicago Tribune on Thursday:
Many of us keep track of our health via a set of easy-to-understand (and worry about) numbers. What’s your weight? How high is your blood pressure? And what’s your cholesterol level?
You know there’s good cholesterol, HDL, and bad cholesterol, LDL. Doctors prescribe statins for people with too much of the bad kind, to lower their risk for heart attacks and strokes. The goal: Reduce the bad cholesterol to a specific, recommended target level.
On Tuesday, however, experts at the American Heart Association and the American College of Cardiology issued groundbreaking new clinical guidelines that upended decades of medical practice. A major takeaway: Researchers said that hitting a cholesterol target should no longer be doctors’ exclusive focus.
The experts now recommend a different approach based on an extensive review of clinical trials. Doctors should sort patients into four groups for which statins are recommended: Patients who have heart disease; all people age 40 to 75 with Type 2 diabetes; people with LDL cholesterol of 190 or greater; and anyone who has a 7.5 percent or greater risk of developing heart disease or stroke in the next decade. The formula for calculating that risk takes into account patients’ age, sex, race, blood pressure, cholesterol levels and whether they smoke or have diabetes.
As a result of the new guidelines, the number of Americans on statins may double to more than 30 million.
Another major change: Some patients who would have been prescribed statins under the old guidelines may now be told to lower their cholesterol the old-fashioned way – via a better diet and more exercise. That’s still a terrific way to prevent high cholesterol and heart disease later in life.
These new guidelines will take some time to sink in. Some critics worry that without target numbers, patients and doctors will lose focus. They may lose the motivation – and satisfaction – of reaching that target.
But people should remember that while guidelines change, medical reality does not. High LDL cholesterol is still bad. Statins are generally safe and reduce the risk of heart attacks and strokes.
As with any significant medical guideline shift, there’s bound to be rampant confusion among patients – and their physicians. Doctors are “going to be scratching their heads,” Yale University cardiologist Harlan Krumholz told Bloomberg News. “They have been taught since medical school they are supposed to lower those patients as much as possible, by whatever method they can.”
There’s no evidence, however, that hitting specific cholesterol targets makes a huge difference. That doesn’t mean that lowering your cholesterol as much as possible isn’t important.
“But the old obsession with, ‘Am I at my target level?' we should de-emphasize,” Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine and a contributor to the new guidelines, tells us. “The question is, ‘Am I doing everything possible to minimize my risk? That’s not just about cholesterol, but losing weight and eating right. That’s the secret to success, not whether your LDL is 71 versus 69.”
That’s intriguing. Turns out these new guidelines provide evidence for something we already know: With statins, as in life, more of a good thing is not always better.