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New Cholesterol Treatment Guidleines
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iride6606 posted:
Forget the numbers, a much deeper dive into the individual's need for statin therapy. The new treatment guideline;

The fundamental shift: Doctors are now being told to no longer adhere to rigid clinical guidelines that trigger the use of a statin when cholesterol levels reach a certain threshold.

Instead, people will be advised to take a statin if they already have heart disease, if their bad (LDL) cholesterol is extremely high (190 milligrams per deciliter of blood or more) or if they're middle-aged with type 2 diabetes.

People between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5 percent or more will also be advised to take a statin. Experts say this new rule could greatly alter the number of patients who will now be advised to take such a drug.

Here's the calculator being used to determine risk;

http://heartdisease.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=heartdisease&cdn=health&tm=10&gps=449_30_1366_595&f=00&su=p284.13.342.ip_&tt=65&bt=0&bts=0&zu=http%3A//cvdrisk.nhlbi.nih.gov/calculator.asp

This would double the number of people who are eligible for statin treatment. Doctors are also being advised to focus on statin treatment and ignore alternative treatments like chelation and other drugs outside the class of statins. This decision was made in part based on the most recent studies showing the safety and effectiveness of statin therapy. Interesting developments.

http://www.nlm.nih.gov/medlineplus/news/fullstory_142445.html

http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a
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bobby75703 responded:
Dr Steven Nissen said it best concerning the abandoning of LDL targets.

"The evidence was never there" for the LDL targets, he said. "Past committees made them up out of thin air" he added.

Yep, I would agree.
 
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iride6606 replied to bobby75703's response:
The part of the quote not included;

"Those goals, of less than 70 or less than 100 [mg/dL>, were never based on any kind of careful scientific study,"

He still supports cholesterol as a risk factor for heart disease. And he said this week;

There was a very large study known as HPS, the Heart Protection Study, that looked at statins in one group of patients versus placebo, a sugar pill, in the other. And it didn't seem to matter where the levels of LDL cholesterol started.

If you had high risk, and you got a statin drug, your risk went down, and it went down a lot, on the order of 25 to 35 percent for the things we really care about like heart attack, stroke and death.

So, take a statin, cholesterol goes down, risk goes down, same message.

He said about the fact that the number of individuals that will be on statins is projected to double;

I'm okay with it. Let me just point out, by the way, that there's only one of the statins that's still branded. Lipitor went generic several years ago. We can get these drugs for most patients for as little as $10 for a three-month supply. So there isn't a profit motive anymore here, and I think that makes it a whole lot easier to accept the guidelines.

Takes the wind out that same old "statins feeding the money machine balloon", doesn't it.

Nissen also said

treating patients with a calculated risk exceeding 7.5% is a lower threshold for treatment than previous guidelines and likely expands the use of statins to millions of patients who would not have otherwise been treated under the ATP III guidelines. What will help is that the drugs are so cheap, now that all the statins, with the exception of rosuvastatin, are available as generic medications.

"Statins have had a profound impact on the risk of morbid and mortal events for heart disease. They are generally very safe. The old guidelines previously emphasized the treatment of patients in older age groups. Now it's easier to look at people in their 40s or 50s and have them reach a 7.5% risk. In many ways, that's good, because if you wait until people are older to treat them, they'll already have vascular disease by the time you begin treatment. The point of treatment is to prevent disease."

You think statins are widely prescribed now, just wait. It will be like taking aspirin.

All in all, pretty much proves what was thought all along. Well done!

Met you goals already, good job.
 
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billh99 responded:
That is not the new risk calculator.

Here is the one associated with the new guidelines.
http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp

It is in the form of a downloadable spreedsheet.


And some one as made it into an online calculator.
http://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx
 
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billh99 replied to bobby75703's response:
Actually there are still LDL targets. Just in a different form.

Depending on the classification it is either high intensity therapy, statins upto the max dose to reach a >= 50% reduction in LDL levels.

Or moderate intensity therapy, enough statins to reach a 30%<= to < 50% reduction.
 
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iride6606 replied to billh99's response:
This is absolutely correct, the line in the sand was just moved. LDL is still a risk factor and is now being reviewed with one's individual risk. Nothing has changed.
 
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iride6606 replied to billh99's response:
Interesting, the one I posted was from the NIH based on the new guidelines. This schematic shows a much higher dependence on TC and places much more importance on cholesterol levels than one would think reading the new guidelines. For instance, if I do mine at my actual TC of 151 my risk is 4.0%, however if I move it to 240 my risk would go up to 8.5% which would clearly push me into the treatment group.

I read an article but I can't post it as it's from a source where my institution is a paid member. The hypothesis is the vast majority of those on statins will have their LDL levels increase to a level sufficient to put them back into the treatment group based on the new guidelines if taken off their meds so this is all really a moot point. The new members of the treatment group will come from the 7.5% risk assessment guideline which could double the amount of people on statins.

What is happening here is something that has been in debate for years, should statins be used to prevent cardiovascular disease in otherwise healthy individuals. The decision has clearly been made that says yes, more statins to prevent more disease. This validates the cholesterol theory and the effectiveness and safety of statins.
 
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iride6606 replied to iride6606's response:
So I just got done reading the official document which is very extensive and the conclusion is that not much has changed.

Let me explain, what some here will read as an increase in the recommended level of LDL from 130 to 190 is actually just an additional risk factor included to capture anyone with familial hypercholesterolemia. If you read the functions and inputs of the risk calculator, they have moved the cholesterol risk to that function. Anyone with a TC between 200 - 320 are bumped into a higher risk factor. Anyone with a TC over 320 bumps into the higher risk stratification which may qualify for more aggressive treatment. As I look into the specific function of the calculator, anyone with a TC over 200 (which is the existing guideline)and older than 40 and a male will more than likely have a 10 year risk score right at 7.5% and make them eligible for statin treatment. In fact, the way this operates all males will eventually hit 7.5% as they age.

Again, basically this is a way to make statin therapy open to more patients in an effort to PREVENT heart disease and stroke.

Very well done...............


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