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Some Doctors Challenge New Statin Guidelines

They say too many people would get the cholesterol-lowering drugs; heart groups defend the recommendations

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"We're acknowledging the unique judgment of a physician when he looks at the patient's specific condition," said Dr. Neil Stone, chair of the AHA's cholesterol guideline committee and a professor of preventive cardiology at Northwestern's Feinberg School of Medicine.

Cardiologists are concerned that the confusion surrounding the calculator and new cholesterol treatment guidelines could cause patients to refuse to take statins.

"I fear that the confusion is going to shake the public's confidence in these lifesaving drugs," said Dr. Kevin Marzo, chief of cardiology at Winthrop-University Hospital in Mineola, N.Y. "It is my hope that the guideline writers will revise the online calculator so that any deficiencies created will be quickly corrected."

The two heart groups unveiled the calculator last week in connection with aggressive new guidelines for combating high cholesterol. Those guidelines call for the use of statins to treat more people.

Previously, doctors adhered to rigid clinical guidelines to prescribe a statin when cholesterol levels reached a certain threshold.

Under the new guidelines, people will be advised to take statins based on a number of different health risk factors. These risk factors include 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.

In addition, people between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5 percent or more are 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.

"We've come up with an approach that calls for treating about a third of adults between 40 and 75 years of age with statins for primary prevention," said Dr. David Goff, co-chair of the risk assessment working group for the guidelines and dean of the Colorado School of Public Health at the University of Colorado-Denver.

"I think it sounds about right," given that one out of three adults in America die from heart disease and stroke, Goff said.

The alleged problems with the calculator prompted at least one prominent cardiologist to tell the Times that implementation of the new cholesterol treatment guidelines should be delayed.

"It's stunning," Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, told the newspaper. "We need a pause to further evaluate this approach before it is implemented on a widespread basis."

Dr. Sidney Smith, a cardiologist at the University of North Carolina at Chapel Hill and a past AHA president, said that would not happen.

"We intend to move forward with these guidelines and develop effective strategies to implement them," Smith said.

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Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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