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House Calls: New cholesterol guidelines issued

Twice as many patients will be recommended to start cholesterol lowering drugs based on new research that came out Nov. 12. The number of adults considered to benefit from statins, cholesterol lowering drugs, could rise to as high as 30 percent.

High cholesterol is one of the major contributors to heart disease and stroke. Heart disease is the leading cause of death in the United States accounting for nearly 500,000 deaths per year with an annual cost of more than $200 billion a year.

The average patient will notice two major changes in the way their doctor will manage their cholesterol. Doctors previously prescribed statins based on patients LDL or bad cholesterol lab numbers. Now the new recommendations recommend that doctors prescribe medicine based on their overall risk factors of developing heart disease or stroke. Risk factors would include race, age, smoking, weight, diabetes, and hypertension. Studies show that even people with normal cholesterol can have heart attacks or strokes.

These new guidelines will focus doctors on the whole patient instead of lab values. While lab values will still be used by your physician, it will be used as a risk factor not as the only value to be considered. These new guidelines will focus on four high risk groups for heart disease and stroke. These risk groups are people who have pre-existing heart disease, patients who are diabetic between ages of 40-75, people that are at high risk for developing heart disease in the next 10 years based on risk factors, and patients with cholesterol levels of LDL greater than 190. The new advice also recommends statins for anyone with type I or type II diabetes regardless of risk factors.

The focus on the guidelines is on the statins and their place in your health. Statins do lower your cholesterol, however, they also reduce the risk of heart disease and stroke even when the cholesterol levels are still high. This fact leads us to believe statins are risk lowering drugs not only cholesterol lowering drugs. They are thought to lower inflammation of blood vessel walls which contribute to plaque formation which can lead to strokes or heart attacks.

The new guidelines are clear, more people should use statins to reduce risk of heart disease and stroke. If you cannot tolerate a statin, you should try another one. Statins do come with some side effects. Muscle pain and changes in liver enzymes have been found. Your doctor will generally check your liver function tests when he/she checks your cholesterol levels. Research is currently being done to see if putting everyone on statins over a certain age would be beneficial. However, this study is not completed as of this date.

Other risk factors that were investigated in this new study were the management of overweight and obese adults. BMI and waist sizes were used to determine risk factors. These numbers will then be used to help your doctor determine if you would benefit from a weight loss program or surgery. The guidelines also focused on exercising three to four times weekly and eating a diet high in vegetables, fruits and whole grains. Also salt reduction of less than 2,400 mg of sodium a day helped to prevent hypertension.

The new guidelines do put an emphasis on statin drugs but the recommendations don’t replace reduction of risk factors such as stopping smoking or watching your diet and exercising. Consult your physician on all your health needs but this is the newest and latest on stroke and heart disease prevention.

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