For years, doctors prescribed the cholesterol-lowering drugs known as statins based largely on cholesterol test results. But new guidelines from the American Heart Association and the American College of Cardiology propose a major change to that strategy, reports the February 2014 Harvard Heart Letter.
"The new guidelines shift away from a target-driven approach to a risk-driven approach," says Dr. Reena Pande, a cardiologist at Harvard-affiliated Brigham and Women's Hospital and an instructor in medicine at Harvard Medical School. Instead of striving to reach a specific cholesterol value, doctors should consider a person's entire cardiovascular risk profile, she explains.
The biggest change is for those who don't have heart disease but are at risk for it. For them, doctors should use the risk calculator on the American Heart Association's website to help determine if taking a statin makes sense. The calculator considers age, sex, race, total cholesterol, "good" HDL cholesterol, blood pressure, diabetes, and smoking history. One thing the guidelines don't take into account, however, is family history, Dr. Pande notes. Anyone with a parent who was diagnosed with heart disease before age 50 is at higher-than-average risk, regardless of cholesterol level.
The guidelines also help doctors identify the right statin at the right dose. For example, someone with a history of heart disease may need a high-intensity statin such as atorvastatin (Lipitor), while someone with a lower risk could take a low-intensity statin, such as pravastatin (Pravachol).
There are enough nuances in the guidelines that it's important to work closely with a doctor to make a personalized plan for cardiovascular health—not only with statins and other medications but through everyday habits, too.
Taking a statin is not a free pass to an unhealthy lifestyle. It's just one part of the staying healthy puzzle, says Dr. Pande. Diet is a key component, as is regular exercise, which boosts protective HDL.
Read the full-length article: "The new strategy for statins: Should you be taking one?"