In short, the new guidelines have changed dramatically, moving away from using LDL as the key measure of CV health, and instead focusing on age, lifestyle, race, and other factors to determine who is most at risk. What’s alarming to many is that the new recommendations make millions more people eligible for long-term preventive treatment with statins.
You get a statin, and you get a statin….
Over the past few years, the American College of Cardiology (ACC), American Heart Association (AHA), the National Heart, Lung, and Blood Institute (NHLBI), and other stakeholder and professional organizations collaborated to develop new clinical practice guidelines. Using data from randomized controlled trials, they worked to determine which populations are most likely to benefit from lifestyle adjustment and statin therapy.
The new guidelines consider age, weight, blood pressure, and other lifestyle and health factors, like smoking or diabetes. When someone has even a moderate risk of a heart attack or stroke based on these measures, the guidelines say that they should be prescribed statins, no matter what their LDL levels are.
There are several ways that these changes can be seen as improvements. For one, this is the first time a major guideline has focused on estimating risk for both heart attacks AND strokes. The guidelines also take race into account—African-Americans face greater risks for heart disease and stroke than other racial groups. The new calculations also make the decision to prescribe statins less complicated for physicians.
If the calculations are accurate, that is.
Once the risk calculator (which you can download here) was released, and people began using it in the real-world, it became clear that this calculator has some flaws. In many cases, the calculator overestimates risk in some populations, which could lead doctors to over-prescribe statins, targeting people whose risk-levels don’t warrant treatment.
Positive perspective. Flawed solution.
The change in perspective is healthy—we know that it’s not just LDL that leads to cardiovascular damage.
We know that long-term inflammation leads to CVD, and that the risk of heart attack and stroke increases as vascular inflammation allows plaque to build up inside the artery walls.
We know that statins reduce/prevent that inflammation, so we understand the reason that doctors prescribe these drugs to at-risk people and keep them on it for decades.
But what we also know is that there are other methods of interrupting the inflammatory process.
Statins were designed as cholesterol-lowering drugs. The reduction they caused in inflammation was only discovered later—it was a side-effect of treatment. There are other, more direct ways of reducing inflammation and improving its related biomarkers, like hs-CRP, cortisol, fibrinogen, and homocysteine.*
It makes sense for people at low to moderate risk to start with effective alternatives to statins. Practices that are known to directly reduce inflammation in the body over time include reducing carbohydrate intake, taking adaptogens, working toward proper omega balance, and just generally calming down.
Not only are these treatments strategies effective, but they are more highly tolerated than statins, which can have negative effects on muscle and cognition. And treatments with fewer side-effects make it easier for people to keep up a long-term healthy regimen without interruptions.
The future of CV care
Some believe that the solution to these one-size-fits-all guidelines could be found in the data from a nationally integrated electronic health record system that collects data for scientific research—testing risk calculators, tracking side effects, and monitoring the efficacy of drugs in the real-world.
But seeing the state of the US health care system, it seems that this is a distant dream. That’s why it’s important for us to do what we can to maintain our own data, seeing trends and the effects of treatment over time.
The controversy is sure to continue, with arguments fueled, at least in part, by specialists and researchers with varyingly close relationships to pharmaceutical interests. Read more about the new guidelines and its critics for yourself, and see where you stand in this new era of treatment.
The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice of any kind. Any information in these posts should not be acted upon without consideration of primary source material and professional input from one's own healthcare professionals.