About one in six adults in the United States has high cholesterol—that’s approximately 17% of the country’s population—according to the US Centers for Disease Control and Prevention. High cholesterol significantly raises the risk of heart attack and stroke, and with heart disease remaining the No. 1 cause of death in the US, the American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice released new recommendations on the subject in November.
Published in both Circulation and the Journal of the American College of Cardiology, the “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults” outlines new ways to measure and address high cholesterol among different patient populations. The updated recommendations focus on four groups that will most likely benefit from cholesterol-lowering statin therapy. These include:
• Patients who have cardiovascular disease
• Patients with a low-density lipoprotein (LDL), or “bad” cholesterol, level of 190 mg/dL or higher
• Patients between the ages of 40 and 75 with diabetes and LDL levels of 70 mg/dL to 189 mg/dL
• Patients between the ages of 40 and 75 with LDL levels of 70 mg/dL to 189 mg/dL and whose 10-year risk of heart attack or stroke is 7.5% or higher as determined by the AHA’s new cardiovascular risk calculator, available here.
The guidelines were revised because the previous recommendations were based on the Framingham Heart Study, a comprehensive trial that evaluated study subjects’ heart health over a significant time period, but that included a homogenous study pool composed mostly of white men. The newly released guidelines used studies that included more diverse patient populations, as some groups, such as African Americans and women, are at significant risk of cardiovascular disease and stroke.
Controversy surrounds the guidelines and cardiovascular disease risk calculator, however. Authors of the paper, “Statins: New American Guidelines for Prevention of Cardiovascular Disease,” published November 30 in The Lancet, note that the risk calculator may overestimate cardiovascular disease risk by two-fold, vastly increasing the number of people recommended for statin therapy.
The ACC/AHA task force counters that the risk calculator should be just one facet of a comprehensive risk assessment, and that many other factors—such as family history, lifestyle, and levels of C-reactive protein—should also be considered. It also asserts that the guidelines are but one part of a clinician’s toolkit for reducing patients’ risk of cardiovascular disease and stroke.
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