Debate Rages on About the New Cholesterol Guidelines

December 2, 2013

Cholesterol Guidelines


A leading cardiologist is demanding a halt on a recently released online cholesterol risk calculator and cholesterol-lowering guidelines developed by the American Heart Association (AHA) and American College of Cardiology (ACC). The calculator may be seriously flawed and could overestimate cardiovascular risk by 75 to 150 percent, reports the New York Times. Both heart organizations, however, vehemently stand behind the cholesterol calculator and guidelines, stating that they relied on a broad range of patient data in its development and although the calculator is not perfect, it’s a big step forward.

The Debate

The calculator provides a cholesterol risk assessment and estimates a patient’s risk of having a heart attack or stroke within a 10-year period. At the root of the heated debate is concern over millions of people mistakingly and excessively being prescribed statins, cholesterol-lowering drugs. Physicians prescribe statins as reasonable treatment for a majority of patients with high cholesterol to reduce their risk of having a heart attack or stroke.

Not only do the inaccuracies of the calculator create concerns that patients would unnecessarily take statins based on a false assessment, miscalculations can also have the opposite effect. Patients could become even more skeptical about statins. The distrust could discourage high-risk patients with diabetes or a history of heart disease from taking the medication when it’s in their best interest to do so.

Two professors from Harvard Medical School, Dr. Paul M. Ridker and Dr. Nancy Cook, identified the calculator as problematic earlier this year. The National Institutes of Health’s National Heart, Lung, and Blood Institute originally developed the guidelines. After reviewing the drafts, the professors were unsatisfied, yet their concerns were ignored.

"We need to pause to further evaluate this approach before it is implemented on a widespread basis," Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic and past president of the American College of Cardiology, said to the Times.

The Rebuttal

During the annual American Heart Association meeting in November, the AHA and ACC explained the calculator is for patients and doctors to use as a guide while considering treatment options. The organizations “advised against blind adherence to the calculator,” Time magazine reported. Doctors are still encouraged to follow the guidelines.

Officials also responded to statin concerns by saying the calculator is merely a suggestion for people who would benefit from the medication. The calculator is intended to prompt conversation between a patient and his doctor about options for lowering cholesterol. Based on the guidelines, patients are advised to take statins if they qualify under risk factors such as having heart disease, extremely high LDL cholesterol or type 2 diabetes

After Dr. Nissen advocated a delay in implementing these guidelines, Dr. Sidney Smith, a cardiologist at the University of North Carolina at Chapel Hill and former AHA president, told U.S. News & World Report, “We intend to move forward with these guidelines and develop effective strategies to implement them.”

Healthy Cholesterol

The controversy highlights the dangers of high cholesterol and heart disease. More than 100 million Americans are at risk for clogged arteries, heart attacks and strokes because of high cholesterol, according to Take control of your cholesterol and reduce your risk of heart disease with the following lifestyle changes and treatments: