New Cholesterol Drug Guidelines: Q&A
Q: After the guidelines were released, some doctors questioned how the calculator works, saying it overestimates how many people need statins. What advice would you give to people about the calculator and how to use it?
Henry says people can still use the calculator. “No risk calculator will be perfect,” Henry says. “It provides a relative risk for the patient based on established risk factors.”
Another doctor tells patients not to use it on their own. “Having used the calculator in over 100 patients, I agree that the [need for] statin use is overestimated,” says Ravi Dave, MD, of the UCLA Medical Center in Santa Monica. “I am using the guidelines with my clinical judgment and a patient’s specific history to guide me,” he says. “These are just guidelines.”
Q: If people start taking a statin, will they be expected to get their bad cholesterol to a certain number?
Rather than target a specific number, doctors will try to lower your cholesterol by a certain percentage, Dave says. How much your doctor expects you to lower your cholesterol will depend on your level of risk, he says, and whether the goal is aggressive- or medium-risk reduction.
If you are at high risk, the goal will be to cut the bad cholesterol by half. If you have some risk, your doctor may tell you to lower your cholesterol by 30% to 50%, he says.
Lowering cholesterol in this way helped people avoid heart attacks and strokes in the studies the experts looked at.
"We were much too focused on a number," Dave says. "Patients had to reach a certain number to determine success." Few patients did that, he says.
Q: Did the drug manufacturers have any role in this recommendation?
"None, actually," says Robert Eckel, MD, professor of medicine at the University of Colorado. He was a member of the cholesterol guidelines panel.
"People [on the panels] who felt they were conflicted did not vote on the guidelines," he says.
The expert panel looked at many studies to make its decision, the doctors say. For instance, studies showed that lowering bad cholesterol levels by 30% to 50% in patients at moderate risk could lower their chance of having a heart attack.