New Cholesterol Guidelines Call for Increased Drug Use

A federally sponsored panel issued new cholesterol guidelines yesterday, proposing that the number of Americans on cholesterol-lowering drugs triple to 36 million and that the number on cholesterol-lowering diets should increase from 52 million to 65 million, the New York Times reports. The 200-page guidelines, the first since 1993, were issued by the National Cholesterol Education Program of the National Heart, Lung and Blood Institute, a division of the NIH and appear in today's Journal of the American Medical Association (Kolata, New York Times, 5/16). The guidelines represent a "much more ambitious effort by public health officials to reduce disability and deaths" from heart attacks, the nation's leading cause of death, the Washington Post reports (Squires, Washington Post, 5/16). The recommendations "significant[ly]" broaden the "definition of people considered good candidates for aggressive" cholesterol drug treatment, which studies have shown lowers the risk of heart attacks by 20% to 30%, the Los Angeles Times reports.

Under the 1993 guidelines, drug therapy was recommended for heart disease patients, individuals with low-density lipoproteins -- LDL, known as the "bad" cholesterol -- exceeding 189, and people with two or more risk factors for heart disease and LDL scores of 160 or higher after dieting. The new guidelines expand this list to include all diabetes patients, "people with evidence of asymptomatic arterial thickening or buildup," and people with more than one risk factor for heart disease "whose projected 10-year heart disease risk is 20% or higher," calculated through a "combination of factors," including age, smoking, and blood pressure (Carey, Los Angeles Times, 5/16). Margo Denke of the University of Texas-Southwestern in Dallas, who helped draft the guidelines, said, "The old way of thinking was, 'Yes, wait three months and try the diet and only start on the medications if you need to.' The new way is ... we're just going to start medication right away to lower immediate risk. We're not chucking the diet, but we're saying we need to pair it with medication" (Washington Post, 5/15). The full report and related information, including a "10-year risk calculator" for heart disease, can be found at http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm.