thanx to the guideline I am now more thoroughly confused than ever about statin use
Major New Guidelines on Reducing Cardiovascular Risk Released — Physician’s First Watch
Major New Guidelines on Reducing Cardiovascular Risk Released
By Joe Elia
Guidelines encompassing four major areas aimed at reducing the risk for cardiovascular disease have been released.
The guidelines, appearing in Circulation, are likely to change clinical practice. They are the result of collaborations among the American Heart Association, the American College of Cardiology, and other organizations.
Some major recommendations from the four areas follow:
Obesity: There's no ideal diet for weight loss. Intensive, supervised lifestyle changes for at least 6 months receive strong endorsement.
Lipids: There's no longer any support for treating to specific lipid targets.
Risk Assessment: The guidelines offer a new calculator for measuring 10-year risk (we provide a link below).
Lifestyle: The guidelines emphasize heart-healthy diets and advocate restrictions to the intake of saturated fats, trans fats, and sodium.
The NEJM Journal Watch editors are reviewing the individual recommendations, and Clinical Conversations interviewed cardiologist Harlan Krumholz to get his perspective.
Reader Comments (6)
Journal Watch provides valuable information on wide range of medical topics which are useful.
The risk calculator, as downloaded, shows that any male over the age of 63, regardless of other risk factors, will have a 7.5% or greater 10 year risk. The guidelines therefore advise treating EVERY male over 63 (and every female 71 and older). I find this difficult to follow in my practice.
The cardiovascular and cerebrovascular guidelines are appreciated, but overdue. Given the lack of benefit of fibrates, omega-3 supplements, niacin, and folate (despite their lipid level effects), it seems clear that the endothelial benefits of statins are the major benefit. We still need to consider other statin benefits suggested in other (esp. non-USA) studies: reductions in dementia, malignancies, and infections). The benefits can only be expected to broaden.
according to these new guidelines, a 62 year-old black male with no other risk factors (non-smoker, non-diabetic, non-hypertensive, with SBP 120, TChol 170, and HDL 50) should be prescribed a statin. This despite no evidence that statins reduce mortality (or morbidity) in primary prevention in anyone.
I question the legitimacy of the guideline choices and wonder if they are in the best interests of patients. I realize the development of atherosclerotic plaques are multifactorial, but giving up on strict management of lipid goals seems premature.