The cohorts were drawn from the Framingham Heart Study,4 the Coronary Artery Risk Development in Young Adults,5 and the Cardiovascular Health Study.6 We found that evidence did not support the earlier paradigm of basing treatment only on cholesterol levels without examining other risk factors.

So it is true that patients without elevated cholesterol might be deemed at high risk and treated with a statin drug. On the other hand, patients with elevated cholesterol but no other risk factors might not be candidates for statin treatment and may be taking statins unnecessarily.

How do you suggest that clinicians apply the new guidelines in daily practice?


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A guideline is not a mandate. Practitioners must use their clinical judgment on a case-by-case basis. And they must remember that lifestyle changes are critical in primary prevention.

I recognize that the concept of treating the whole patient rather than the patient’s numbers is a major paradigm shift that will be adopted slowly, but it will ultimately lead to an important reduction in ASCVD events.

References

1. Stone NJ, Robinson J, Lichtenstein, AH et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2013. Available at:  http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf+html. Accessed: December 2, 2013.

2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. (Adult Treatment Panel III). Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf. Accessed: December 3, 2013.

3. Prevention Guidelines Tools: CV Risk Calculator. Dallas: American Heart Association, 2013. Available at: http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp. Accessed: December 3, 2013.

4. National Heart, Lung and Blood Institute [NHLBI]. Framingham Heart Study. Available at: http://www.framinghamheartstudy.org/index.php. Accessed: December 3, 2013.

5. Coronary Artery Risk Development in Young Adults (CARDIA). Available at: http://www.cardia.dopm.uab.edu. Accessed: December 3, 2013.

6. National Heart, Lung and Blood Institute [NHLBI]. The Cardiovascular Health Study. Available at: https://chs-nhlbi.org. Accessed: December 3, 2013.


To look at any of the articles in this series, click below.

Part 1: Cardiovascular Risk Assessment
Part 2: Lifestyle Management
Part 3: Panel Member Addresses Controversies Surrounding New Cholesterol Guideline
Part 4: Management of Overweight and Obesity in Adults