Six new items in the new cholesterol guideline:
The new cholesterol guideline clearly states that it has the following six new items that deviate from old guidelines. This is not the actual guideline but is more like the guiding principles. I will summarize the actual cholesterol guidelines after listing these items.
1. Focus on prevention of heart attacks and strokes:
The new guideline puts cholesterol in the context of all other risk factors and moves away from treating the numbers per se.
2. Less emphasis on actual reduction in cholesterol levels:
The new goal of treatment is to reduce risk of heart attacks and strokes. They no longer emphasize the goal of reducing cholesterol to a target level.
3. Identify and discuss treatment plan with patients at high risk for heart attack and strokes:
The new guideline suggests that decision to treat needs to based not only on the cholesterol levels but also on the patient’s individual risk profile, age and preference. They have a tool to to estimate individual risk based on age, sex, race, cholesterol levels, blood pressure, diabetes status, and smoking status.
4. Evaluate safety of cholesterol pills:
The new guideline tells doctors to carefully consider the adverse effects of cholesterol pills and discuss the risks/benefits with patients.
5. Role of new lab tests:
The new guideline discusses roles of new lab tests, based on recent research, to help make the decision about starting cholesterol pills when the risk/benefits are equivocal.
6. Future guideline updates:
Identifies factors that need to examined more carefully in the future.
Actual new cholesterol treatment guideline:
The actual cholesterol treatment guideline tells you when to treat high cholesterol. The 2013 cholesterol treatment guideline has three different levels of recommendations:
1. Strongly recommended cholesterol guideline:
This is what they recommend based on the best evidence available. They have a high degree of confidence in these cholesterol guidelines.
The new cholesterol guideline strongly recommends starting cholesterol pills regardless of the cholesterol levels in the following situations:
1. If you are younger than 75 and you already have had heart attacks or strokes
2. If you are younger than 75 you have diabetes
The new cholesterol guideline strongly recommends starting cholesterol pills based on your cholesterol levels if you meet all of the following four criteria:
1. If your LDL (the bad cholesterol) level is in between 70 and 189
2. If you are between 40 to 70 years of age
3. If your risk for heart attack and stroke is very high(greater than 7.5% in 10 years), and
4. You prefer treatment
2. Weakly recommended cholesterol guidelines:
This is what they recommend based on very weak but positive evidence. They have a low degree of confidence in these cholesterol guidelines.
The new cholesterol guideline weakly recommends taking cholesterol pill if you meet all of the following four criteria:
1. If your LDL (the bad cholesterol) level is in between 70 and 189
2. If you are between 40 to 70 years of age
3. If your risk for heart attack and stroke is high(greater than 5% but less than 7.5% in 10 years), and
4. You prefer treatment
3. Expert opinion:
These cholesterol guidelines are just based on the opinion of the doctors and experts that were in the panel to create the guideline. These are not based on any concrete evidence and I have not summarized those here.