New guidelines for taking cholesterol-lowering drugs target cardiovascular risk, not cholesterol level, from the February 2014 Harvard Heart Letter

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.

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