New statin guidelines: The good news
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
The American College of Cardiology and the American Heart Association just released new guidelines recommending that as many as 70 percent more Americans over age 45 should be taking statins. I have studied this thick, complicated document and reviewed the commentaries of several experts.
WHO WROTE THE GUIDELINES?
It is an impressive group of 15 academic scientists and physicians. However, seven of the committee members, including a co-chairman of the committee, have extensive ties with the pharmaceutical industry. To their credit, the authors indicate that those members with conflicts of interest were not allowed to vote on the actual guidelines. Further, be aware that the vast majority of current statin drugs are available as less expensive generics, Crestor being the exception.
HEALTHY LIVING FIRST
These guidelines provide an ongoing emphasis on eating a healthy diet, exercising regularly, avoiding tobacco products and maintaining a healthy weight. The concept that taking my Simvastatin regularly will assuage the damage to my arteries and my guilt for eating French fried onion rings and enjoying regular hot fudge sundaes just does not fly.
WHAT’S NEW IN THESE RECOMMENDATIONS?
First, the guidelines have moved away from achieving target cholesterol levels. Recall the “know your number” campaigns that created neuroses in both doctors and patients worrying about the fact that the LDL cholesterol was 101, rather than 99. For several years, there has been a growing controversy about whether or not statin drugs really worked by reducing cholesterol (cholesterol hypothesis) or by some other mechanism. These guidelines create a chink in the armor of the cholesterol hypotheses.
Second, the committee concluded that non-statin drugs do not provide acceptable heart and stroke risk reduction. So adding Zetia to your statin or taking a combination drug, Zetia-Simvastatin (Vytorin) may lower your cholesterol, but does nothing to protect your heart and brain.
The panel did try to eliminate some of the ever-present bias in American medicine guideline writing by not allowing those committee members with incestuous relationships with the pharmaceutical industry to vote on proposals.
The elimination of the “target LDL cholesterol” is good science and good for patients. It will eliminate the every few months trip to the lab to see where your lipid numbers are. The new guidelines recommend either high intensity or moderate intensity lipid-lowering for those patients with known heart attack or stroke, most diabetics, and those patients with an LDL cholesterol greater than 190.
The guidelines put the kibosh on Merck’s products, Zetia and Vytorin. Both these products lower cholesterol, but they have absolutely no effect on preventing heart attacks or strokes. If you’re taking one of these products, talk to your physician.
Next week, a look at the rest of the guideline. What you should know if you are at low risk for heart disease and stroke. Is there a statin in your future? A risk calculator run amok!
Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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