Minn. MDs, researchers favor new statin guidelines

For nearly a decade, many physicians and patients have lived by the mantra of driving down so-called "bad" cholesterol.

But under new guidelines from the American Heart Association and the American College of Cardiologists, a patient's low-density lipoprotein cholesterol doesn't matter as much.

Instead doctors are being urged to consider using cholesterol-lowering statins on more of their patients to prevent heart attacks and strokes -- a revised treatment plan that likely will place many more Minnesotans on drug therapy.

The two health associations released the new guidelines after conducting an extensive review of recent medical studies. The findings of that review show that the long-held emphasis on reducing LDL cholesterol wasn't based on much evidence.

Dr. Randy Thomas, director of the Cardiovascular Health Clinic at Mayo Clinic in Rochester, said the new guidelines are a dramatic shift in thinking.

"It's going to be a change. It's going to be an adjustment," Thomas said. "But I think it's an advance in a good direction."

The new guidelines identify four risk groups who can benefit from taking statins. They vary by age and include people who have a very high level of bad cholesterol or a history of cardiovascular problems or diabetes. They also include people who don't have any signs of cardiovascular disease, but who have at least a 7.5 percent risk for having a heart attack or stroke within 10 years.

Under the old guidelines, many people with only moderate disease risk were not offered statins. Those patients were undertreated, said Dr. Jay Cohn, director of the Rasmussen Center for Cardiovascular Disease Prevention at the University of Minnesota.

"I hope it means that more people will take a statin drug," Cohn said of the new recommendation. "But what it really should mean is that the right people should take a statin drug; those who don't need it shouldn't be taking it and those who do, should. And we've done a poor job of that up until now."

After years of targeting LDL cholesterol, the sudden switch in thinking could be confusing to patients and doctors.

"The first group that's going to have to sign on to this, just like in the earlier reports, are physicians," said Dr. Russell Luepker, a cardiologist and epidemiologist at the University of Minnesota.

Luepker, who helped craft the previous guidelines targeting LDL cholesterol, supports the new strategy. But he said it will be a little more challenging for doctors who will now have to calculate their patient's risk of disease.

"Although they say it's simpler, in fact it has some complications to it and it's going to take some work before it attains widespread use," he said.

It will also take time for the guidelines to filter out to everyone, especially to primary care physicians who are also responsible for keeping up on many other health conditions.

Thomas Kottke, medical director for population health at HealthPartners, said patients should feel free to ask about the new guidelines even if their physicians don't bring it up.

"If I had an appointment with a physician tomorrow," Kottke said, "I would say, 'Gee, there's new guidelines out. Can we discuss these in the next month or two?'"

The new guidelines represent the first update in eight years regarding cholesterol treatment and some physicians say it has taken far too long to come up with new guidelines. Heart disease is the number one killer of people in the United States, and stroke, number four.

Tom Knickelbine is with the Minneapolis Heart Institute.

"This is something that is so important to Americans and it's so critical that it needs to be revisited at least annually," said Tom Knickelbine, director of preventative cardiology at the Minneapolis Heart Institute.

But while the recommendations on statins are making all of the headlines, Knickelbine and others say it's also important to remember that the new guidelines note that the first line of therapy against heart disease and stroke should be a healthy lifestyle and a diet that promotes lower cholesterol.

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