People who have recently had a heart attack should lower their “bad cholesterol” to rock-bottom levels, according to new guidelines issued Monday.
“The concept here is that lower is better with respect to cholesterol,” said Dr. Steven Nissen, cardiologist at the Cleveland Clinic, who is among those who have studied the issue. “It’ll be hard to get there, but we do have aggressive drugs.”
Heart patients in need of drastic measures can use statin drugs _ including Lipitor - in higher doses or combine statins, which block formation of cholesterol, with drugs that block cholesterol’s uptake by the body.
The new guideline for very high-risk heart patients is lowering their so-called bad cholesterol, LDL, to 70. The previous guideline was 100.
The new guidelines, in Monday’s issue of the American Heart Association journal Circulation, are not a complete surprise. Recent studies have shown that lives can be saved by a drastic lowering of LDL in people who have had recent heart attacks.
Created by the National Cholesterol Education Program, the guidelines are endorsed by the American Heart Association, the American College of Cardiology and the National Heart, Lung and Blood Institute. A panel of the education program examined five major studies involving cholesterol-lowering medicines.
“By doing this we expect further reduction of death from heart disease, as well as heart attacks, and the need for expensive re-vascularization procedures like bypass surgery and coronary angioplasty,” said Dr. Sidney Smith, a co-author, former president of the American Heart Association and professor of medicine at the University of North Carolina.
“I think that the majority of patients - based on the studies _ should be able to achieve these goals,” he said.
Every year, 1.2 million people in America have a new or repeat heart attack. Dr. Scott Grundy, lead author of the guidelines, said that as of 2001 there were about 36 million people who could benefit from drugs to lower their cholesterol. He said that it’s hard to put a number on it, but the new guidelines could increase that number by “a few million.”
The LDL guideline - or option, according to Smith - of 70 is for people who have just had a heart attack or those who already have cardiovascular disease plus diabetes, are persistent smokers and have high blood pressure, or other multiple risk factors.
Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas, said that the updated recommendations call for drug therapy in almost all high-risk patients with levels of LDL higher than 100.
For moderately high-risk people - those who have multiple risk factors and are estimated to have a 10 percent to 20 percent chance of heart attack or cardiac death within 10 years - the new guidelines reinforce the need for treatment if LDL levels are 130 or higher and add an optional consideration of drug therapy if levels are between 100-129.
The guidelines have not changed for those in the lower to moderate risk categories. Grundy said those in the low risk category should be keeping their LDL level at 160 or lower and moderate risk patients should be keeping it at 130 or lower.
Dr. James Cleeman, coordinator of the National Cholesterol Education Program at the National Heart, Lung and Blood Institute, said patients should also be doing things like eating a diet low in saturated fat and cholesterol, exercising and keeping their weight under control.
Revision date: June 20, 2011
Last revised: by David A. Scott, M.D.