The nation’s first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.

The guidelines, issued Tuesday by the American Heart Association and American College of Cardiology, are a big change. They offer doctors a new formula for estimating a patient’s risk that includes many factors besides a high cholesterol level, the main focus now. The formula includes age, gender, race and factors such as whether someone smokes.

The guidelines for the first time take aim at strokes, not just heart attacks. Partly because of that, they set a lower threshold for using medicines to reduce risk.

The definition of high cholesterol isn’t changing, but the treatment goal is. Instead of aiming for a specific number, using whatever drugs get a patient there, the advice stresses statins such as Lipitor and Zocor and identifies four groups of people they help the most.

“The emphasis is to try to treat more appropriately,” said Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel. “We’re going to give statins to those who are the most likely to benefit.”

Doctors say the new approach will limit how many people with low heart risks are put on statins because of a cholesterol number. Yet under the new advice, one-third of U.S. adults — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for about 15 percent of adults.

The latest guidelines have definite benefits and significant drawbacks, said Dr. Eric Topol, a cardiologist and chief academic officer for the Scripps Health network of hospitals in San Diego County.

“The good part is that we’re getting rid of arbitrary target numbers for cholesterol levels,” he said. “We also now recognize that statins are really the only effective medication for lowering the risk of heart disease. Other drugs only reduce LDL (bad cholesterol), but don’t have the broader effect we need.”

On the negative side, Topol said, the new benchmarks increase the danger of people with little to no risk of cardiovascular disease becoming reliant on a statin. “We already have 40 million Americans taking statins. In general, there is overuse of statins, and the latest recommendations could very well worsen that problem,” he said.

Also, some doctors not involved in writing the guidance worry that it will be tough to understand.

The government’s National Heart, Lung and Blood Institute appointed expert panels to write the new guidelines in 2008, but in June said it would leave drafting them to the Heart Association and College of Cardiology. New guidelines on lifestyle and obesity also came out Tuesday, and ones on blood pressure are coming soon.

Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations.

“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” said Dr. George Mensah of the heart institute. He called the guidelines “a very important step forward” based on solid evidence, and said the public should trust them.

Heart disease is the leading cause of death worldwide. High cholesterol leads to hardened arteries that can cause a heart attack or stroke. Most cholesterol is made by the liver, so diet changes have a limited effect on it.

Millions of Americans take statins, which reduce cholesterol dramatically and have other effects that more broadly lower the chances of heart trouble.

The patents on Lipitor, Zocor and other statins have expired, and they are widely available in generic versions for as little as a dime a day. One remaining under patent protection is AstraZeneca’s Crestor, which had sales of $8.3 billion in 2012.

Current guidelines say total cholesterol should be under 200, and LDL, or “bad cholesterol,” under 100.

The broader guidelines say statins do the most good for:

•  People who have heart disease.

•  Those with LDL of 190 or higher, usually because of genetic risk.

•  People ages 40 to 75 with Type 2 diabetes.

•  People ages 40 to 75 who have an estimated 10-year risk of heart disease of 7.5 percent or higher.

Written by Marilynn Marchione AP Chief Medical Writer and posted at the San Diego Union-Tribune, November 13, 2013.

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