and Medicine for Seniors
New Statin Strategy from Lipid
Association Challenges Others
Expert panel urges individualized,
cholesterol-targeted approach to heart disease and stroke
By Tucker Sutherland, editor
15, 2014 – If you thought all the controversy about statin use – a daily
pill for millions of senior citizens - has been settled, you better
think again. An expert panel coordinated by the National Lipid
Association has created its own outline for how to best treat people at
risk for cardiovascular disease and it seems to challenge several
previous recommendations, including guidelines by the American Heart
Association and the American College of Cardiology.
“A recent guideline for using
statins to reduce atherosclerotic cardiovascular disease has wavered too
far from the simple cholesterol goals that have saved thousands of lives
in the past decade, and doesn’t adequately treat patients as
individuals,” says the statement issued today.
The panel says their recommendation
focuses on reducing cholesterol to an appropriate level, and puts less
emphasis on whether or not a patient fits into a certain type of group.
“We continue to believe in
cholesterol targets that are easy for patients to understand and work
toward, first using changes in lifestyle and then medication if
Matt Ito, one of two lead authors on the report. Ito is identified
as “an expert in cardiovascular drug treatments” and a professor in the
Oregon State University/Oregon Health & Science University College of
“We’re also concerned about
treating people just because they fall into a group that’s supposedly at
risk,” Ito said.
“There are ways to more accurately
treat patients as individuals and understand their complete health
profile. And we have a better understanding now of what conditions pose
the most risk for causing a heart attack or stroke, and how to address
that in a comprehensive manner.”
A report issued last year by the
American College of Cardiology and American Heart Association identified
four general groups that would primarily benefit from statins, and its
recommendations if followed will dramatically increase the number of
people using these drugs.
the new report from the National Lipid Association has outlined what
their “experts” believe to be a more individualized set of
recommendations that practitioners could use to treat people at risk of
cardiovascular disease; more information is available
Ito says these recommendations “are
intended to complement the guidelines issued by the American College of
Cardiology and the American Heart Association.”
Among the conclusions in the
>> A root cause of
atherosclerotic cardiovascular disease is cholesterol-containing
particles attaching to the walls of arteries.
>> A healthy lifestyle that
incorporates diet, weight management and exercise should be the first
approach to lowering cholesterol levels that are too high.
>> Control and reduction of LDL,
or “bad” cholesterol is important, but an even better overall marker of
risk is “non-HDL cholesterol,” which is total cholesterol minus its HDL
>> Patients at very high risk,
such as those who have already had a cardiac event, should try to
achieve non-HDL cholesterol levels below 100, while those at lower risk
levels should try to achieve levels below 130.
>> Drug therapies specifically
aimed at lowering triglyceride levels may not be necessary unless they
are very high, over 500; and efforts to specifically raise HDL levels
have been shown to be both less important and less achievable.
>> Use of more potent statin
drugs, at moderate to high doses if necessary, should be the first
approach to reach cholesterol goals if lifestyle changes have not been
>> Use of other medications or
therapies, such as fibrates, cholesterol absorption inhibitors, and
niacin or omega-3 fatty acids can be considered if cholesterol and
triglyceride goals are not reached with statins alone.
>> Non-lipid risk factors should
also be managed, such as high blood pressure, cigarette smoking and
“Cholesterol is still a primary
factor in atherosclerotic cardiovascular disease,” Ito said.
“If it’s too high, the levels
should be brought down by changes in lifestyle and medication if
necessary. And in general, the lower the cholesterol, the better.”
Statins have proven themselves as
one of the most effective way to reduce cholesterol, Ito said, and are
now comparatively inexpensive with limited side effects. Proper
medication management and reducing the potential for drug interactions
can address some types of side effects, and any problems should be
weighed against the risk of heart attack or stroke, he said.
Factors known to raise the risk of
atherosclerotic cardiovascular disease include age, family history,
smoking, high blood pressure, overweight, diabetes, and high cholesterol
levels, especially those caused by genetics.