Not on Cholesterol Meds? New Guidelines May Change That | Drugs & Medications articles | Therapies & Treatments center

For over 25 years, tens of millions of Americans have been told they need to take a statin medication to get their cholesterol levels down.

Under the new approach recently announced by the American Heart Association and the American College of Cardiology, they will just be told they need to take a statin medication, and they will not be expected necessarily to meet cholesterol goals.

Three New Broad Risk Categories

The new approach creates three broad risk categories requiring statin treatment.

Statins will be routinely prescribed to people who already have a condition that increases their risk of cardiovascular disease, such as diabetes, or a prior heart attack.

Statins will also be routinely prescribed to people who have dangerously high levels of "bad," LDL cholesterol, to everyone who has an LDL of 190 or higher.

Also asked to take statins will be everyone else who has a risk of at least 7.5% of having a heart attack or stroke in the next 10 years, based on a calculation with an online spreadsheet tool that takes into consideration age, blood pressure, total cholesterol level, and ethnicity.

But people in these categories will no longer be told to get their cholesterol down to 70 or lower by rigorous dieting or increasing dosages or by switching medications, typically to Crestor (rosuvastatin). The new risk guidelines calculate risk of stroke as well as risk of heart attack, unlike old calculations of cardiovascular risk.

Some People Will Come Off Statins, Some People Will Go on Them

Before the new guidelines, "high cholesterol" was considered to be a sufficient reason by itself to be placed on statin drugs.

Under the new guidelines, high LDL cholesterol still will be, but when total cholesterol is the only risk factor, statin treatment will no longer be considered unnecessary.

On the other hand, the new guidelines take into account the fact that African-Americans are at substantially greater risk than the rest of the American population for stroke, and many African-Americans who have high blood pressure but lower levels of cholesterol who are not on statins now will be asked to take them.

Non-Statin Cholesterol-Lowering Medications Likely to Be Less Often Prescribed

Since the new guidelines do not require reaching a specific lower cholesterol number, non-statin cholesterol-lowering medications like Zetia (generic name etizimibe, also marketed as Ezetrol) are less likely to be prescribed.

Zetia lowers cholesterol levels by blocking the absorption of cholesterol from food. Because the cholesterol stays in the intestines, the drug commonly causes constipation, sometimes offsetting the constipation caused by the statin drug. But adding cholesterol-lowering drugs to other cholesterol-lowering drugs has never been shown actually to lower the risk of heart attacks and strokes.

Doctors Resist the Idea of Prescribing Fewer Statins

Perhaps predictably, many doctors are already raising objections to changing standards they have used for years.

The new guidelines take age into account.

Someone under the age of 20 would almost never be prescribed a statin, for instance. But some doctors believe that keeping LDL levels to a minimum would stop cardiovascular damage from ever occurring. There is, however, no evidence of lowering normal LDL levels by drugs actually prevents heart attack of stroke.

If The Numbers Don't Make A Difference, Why Have So Many People Been On Statins So Long?

The change in the prescribing guideliness for statin drugs like Lipitor, Crestor, Zocor, Levacor, Pravachol raises an important question: If lowering normal LDL levels is not known to reduce risk of heart attack and stroke, and if the benefit of taking a statin drug is not clearly tied to its ability to lower cholesterol levels, why have so many people been prescribed them.

Dr. Steven Nissen, a cardiologist at the prestigious Cleveland Clinic, had a succinct explanation in an interview with the New York Times: “The science was never there” for the LDL targets, he said.

Past committees “made them up out of thin air." Dr. Nissen is hardly the only physician who has this opinion. In the USA, the Veterans Administration scrapped its LDL guidelines earlier in 2013.

But just because treating cholesterol numbers instead of cardiovascular disease has become standard practice in the USA doesn't mean that statins are useless. It may only mean that the real value of statins has been fighting inflammation, not lowering cholesterol.

Some Doctors Advocate a Holistic Approach

The advantage of dispensing a statin drug to every patient comes along with real, although very small, protective benefit associated with lowering cholesterol levels with medication.

The drug may lower cholesterol levels drastically, by 30% or 40%, giving the doctor something to show the patient while saying, "See, my prescription is making you healthier."

That actual protective benefit of many of the statins in large-scale population studies is more on the lines of 7% to 10% over a 10-year period, that is, patients have a 10% lower risk of having a heart attack over the next 10 years if they take the drug, but patients are not told that. They are simply told to take their pills and their cholesterol levels are amazingly lower.

They aren't given help with weight, or smoking, or triglycerides, and cardiologists are notorious for ignoring diabetes.

Don't Depend on a Statin, or Any Other Drug, to Do It All For You

But a more mature approach to the issue of cardiovascular health is for patients to take primary responsibility for their health.

Since the real value of cholesterol drugs may be their ability to lower inflammation, why not reduce inflammation on your own by eliminating sugar and reducing carbohydrates in your diet, avoiding smoking, and getting enough rest?

And since inflammation of your arteries is not as much of an issue if they are not injured by tension, why not make especially sure you keep your blood pressure under control?

A few minutes every few months with your doctor may be profoundly important to your health, but you are in charge day by day. Let your doctor manage your numbers, but don't forget that it is up to you to manage your life.