NIH Committee Issues New Recommendations on Cholesterol
The National Cholesterol Education Program, an NIH committee, on Monday issued new recommendations that "sharply" reduce the targeted levels of cholesterol for individuals at high and moderate risk for heart disease, the New York Times reports (Kolata, New York Times, 7/13). The committee issued the recommendations, which appear in the current issue of the American Heart Association journal Circulation, as treatment options (Winslow, Wall Street Journal, 7/13). The American Heart Association, the American College of Cardiology and the National Heart, Lung and Blood Institute, have endorsed the recommendations (Stengle, AP/Newark Star-Ledger, 7/13). The NIH committee recommended:
- Individuals at high risk -- those who have heart disease, as well as diabetes and high blood pressure, and smoke cigarettes, or also have "metabolic syndrome," a series of other risk factors such as high levels of triglycerides and low levels of HDL, or "good" cholesterol -- should reduce their levels of LDL, or "bad" cholesterol, to less than 70. Previous recommendations said that such individuals should reduce their LDL levels to 100 or less;
- Individuals at moderate risk -- those who have had a heart attack and have at least two other risk factors -- should reduce their LDL levels to less than 100. Previous recommendations said that such individuals reduce their LDL levels to 130 or less (Stein, Washington Post, 7/13);
- Individuals at high or moderate risk, regardless of their age, should take statins in adequate doses to reduce their LDL levels by 30% to 40%;
- Individuals with diabetes should focus on efforts to reduce their LDL levels (Mestel, Los Angeles Times, 7/13).
The NIH committee issued the new recommendation in response to five recent clinical trials that found the previous recommendations were inadequate and increased prescription drug treatment led to improved results (New York Times, 7/13). Grundy said that recommendations issued by the committee in 2001 estimated that about 36 million U.S. residents could benefit from statins and that the new recommendations could increase the number by a few million (Stengle, AP/South Florida Sun-Sentinel, 7/13). In response to the recommendations, physicians may advise many patients who take statins to increase their dosages (New York Times, 7/13). Experts said that the recommendations could "intensify treatment of patients at the greatest risk and also push millions of others to begin treatment to lower their cholesterol," the Post reports (Washington Post, 7/13). According to Grundy, the committee likely will revise the recommendations in the near future as more trials on statins are completed (Los Angeles Times, 7/13).
Heart disease experts said that implementation of the new recommendations on LDL levels "will not be an easy goal to achieve," the Times reports (New York Times, 7/13). Michael Hudson, director of coronary care unit at Henry Ford Hospital, said, "Smaller changes in diet, which most people are able to do, won't come close" (Anstett, Detroit Free Press, 7/13). As a result, physicians may prescribe many patients higher doses of statins or new combinations of anti-cholesterol medications. However, higher dosages of statins can increase the risk of side effects such as liver problems and muscle pain, and combinations of anti-cholesterol medications would increase the cost of treatment, the Journal reports (Wall Street Journal, 7/13). The authors of the recommendations said that "even with more medication, diet and exercise," some individuals at high risk could not reduce their LDL levels to 70 or less, USA Today reports (Rubin, USA Today, 7/13).
Dr. Steven Nissen, vice president of the American College of Cardiology, said, "There's good news here -- that if we treat the right people and treat them intensively enough, we can reduce the risk of heart attack and death in s substantial proportion of the population" (Los Angeles Times, 7/13). Christie Ballantyne, a cardiologist at Baylor College of Medicine, said that the new recommendations are "an important step forward," adding, "This affects millions of Americans and if implemented should lead to marked benefits by reducing heart attacks and strokes."
However, some experts criticized the NIH committee for "presenting the new targets for high-risk patients as 'options' rather than hard recommendations," the Post reports. Eric Topol, chair of the department of cardiovascular medicine at the Cleveland Clinic, said, "As usual, the medical community is moving slower than the evidence and data support." The authors of the recommendations "defended their decisions" and said that clinical trials currently in progress "should provide more definitive data within the next year or two," the Post reports. Grundy said, "We have to be a little cautious about not being overly aggressive right now because we don't know how these trials are going to turn out." Daniel Rader of the University of Pennsylvania School of Medicine said, "I think it's a somewhat nuanced approach, but it's reasonable given the current situation." He added, "It's a very big deal. It will increase the number of people who require more aggressive therapy dramatically" (Washington Post, 7/13).