The latest recommendations of the US to treat cholesterol leave a clear message. ‘If you are not being treated with statins, drugs that lower cholesterol, do not worry, soon have to take them.’ The guidelines, published yesterday by the American Heart Association (AHA) and the American College of Cardiology (ACC) suggest that starting treatment with these drugs, the only focus on should be on the cholesterol levels, but other risk factors such as obesity, physical inactivity and diabetes. And this approach could double the number of people in the US should be treated to reduce cholesterol.
The new guidelines are revolutionary because they represent a ‘sea change in policy on whom to treat,’ says Steven Nissen of the Cleveland Clinic in the US. It is no longer figures reduces cholesterol, but a more comprehensive approach. ‘For many years, the goal has been to get cholesterol levels below 100’, Nissen explains. But now that goal has been completely removed. ‘And instead the guidelines suggest the use of specific risk factors to determine who should be treated with statins and who should simply make lifestyle changes.
If you answer ‘yes’ to any of these four questions – Do you have heart disease? Do you have type 1 or 2 diabetes? Is your level of LDL or lower than 190? And is your risk of a heart attack in the next 10 years increased from 7.5%? (The guides give a formula for establishing this risk). Then according to the new guidelines, the patient should be treated with statins. And for those who do not meet this criterion, the document simply suggests changes in lifestyle.
‘It’s about creating the most appropriate treatment,’ says Neil Stone of Northwestern University and coordinator of the panel of researchers that made the recommendations. In his opinion, with the new guidelines, ‘doctors only prescribe statins to those who will benefit most.’
The authors estimate that the recommendations of the new guidelines will reduce the number of people treated with statins simply because they have a certain amount of cholesterol, despite having a low cardiovascular risk. However, it is estimated that the number of US adults who take statins may have amount to 15.5% today to 31%, almost 35 million people.
Besides economic aspects that will medicate more than 35 million Americans, the use of statins in a much broader population can be a controversial issue. While some experts recommend taking statins to all adults over 45 years for its potential benefit of being anticancer, others warn of its side effects as muscle pain, potential increase in liver disease and risk of developing type 2 diabetes.
But the report also stresses the importance of lifestyle in controlling cholesterol and to prevent cardiovascular disease. ‘The cornerstone of all guidelines is a healthy lifestyle, especially in younger, when changes are reversible,’ says Stone.
In fact, another document prepared by the AHA , the ACC and the American Society of Obesity, stresses the importance of addressing obesity as a disease. The recommendations, published in Circulation, Journal of the American College of Cardiology and Obesity, have been developed to assist health professionals to address the problem of obesity. Do not forget that in the US, there are over 155 million people with obesity or overweight.
‘Weight loss is not a mere matter of willpower. This is the behavior we have with food and physical activity, and to change these behaviors, we need help,’ says Donna Ryan, co-chair of the committee that prepared these guidelines.
The new report is based on a systematic review of the scientific evidence on the risks of obesity and the benefits of weight loss.
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