Long-awaited revisions to cholesterol clinical guidelines have dialed back previous recommendations to use cholesterol-lowering drugs to force ‘bad’ cholesterol below predetermined targets.
The guidelines, issued 12 November by the American College of Cardiology and the American Heart Association, aim to reduce the risk of cardiovascular disease, and come with a range of familiar recommendations including regular exercise and a low-salt diet.
But cardiologists — and pharmaceutical companies — have been eager to see how the guidelines would address the use of blockbuster drugs called statins to hit cholesterol targets. Although it is generally recognized that lower is better when it comes to LDL (bad) cholesterol, doctors and researchers have disagreed over the measures taken to get there. The push to meet LDL targets has led some doctors to prescribe high doses of statins, sometimes combining multiple cholesterol drugs. Although that may lower LDL levels, it also boosts the risk of side effects from the medications. And critics of the approach have argued that there is not enough evidence showing that higher doses of cholesterol-lowering drugs reduce the risk of heart attacks and cardiovascular disease.
The guidelines released yesterday share this concern, noting that an expert panel was unable to find sufficient support for boosting statin doses to hit the targets laid out in previous guidance. Although high-intensity statins are still recommended for some high-risk patients, others are advised to stop at moderate doses.
The long-delayed revision was first undertaken by the US National Heart Lung and Blood Institute in 2008, but in June this year the institute decided to hand the reins for clinical guidelines to external partners.