[Press release] Taking statins to lower cholesterol? New guidelines

From the 4 February 2014 Mayo Clinic Press Release

ROCHESTER, Minn. — Feb. 4, 2014 — Clinicians and patients should use shared decision-making to select individualized treatments based on the new guidelines to prevent cardiovascular disease, according to a commentary by three Mayo Clinic physicians published in this week’s Journal of the American Medical Association.

Journalists:  Sound bites with Dr. Montori are available in the downloads.

Shared decision-making is a collaborative process that allows patients and their clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.

In 2013, the American College of Cardiology and the American Heart Association issued new cholesterol guidelines, replacing previous guidelines that had been in place for more than a decade. The new guidelines recommend that caregivers prescribe statins to healthy patients if their 10-year cardiovascular risk is 7.5 percent or higher.

“The new cholesterol guidelines are a major improvement from the old ones, which lacked scientific rigor,” says primary author Victor Montori, M.D., Mayo Clinic endocrinologist and lead researcher in the Knowledge and Evaluation Research Unit. “The new guidelines are based upon calculating a patient’s 10-year cardiovascular risk and prescribing proven cholesterol-lowering drugs — statins — if that risk is high.”

However, Dr. Montori cautions that the risk threshold established by the guideline panel is somewhat arbitrary. Instead he recommends that patients and their clinicians use a decision-making tool to discuss the risks and benefits of treatment with statins.

“Rather than routinely prescribing statins to the millions of adults who have at least a 7.5 percent risk of having a heart attack or stroke within 10 years, there is an opportunity for clinicians and patients to discuss the potential benefits, harm and burdens of statins in order to arrive at a choice that reflects the existing research and the values and context of each patient,” he says.

“We’re creating a much more sophisticated, patient-centered practice of medicine in which we move the decision-making from the scientist to the patient who is going to experience the consequences of these treatments and the burdens of these interventions,” Dr. Montori explains. “Decision-making tools can democratize this approach and put it in the hands of millions of Americans who have their own goals front and center in the decision-making process.”

Additional authors of the commentary include Henry Ting, M.D., and Juan Pablo Brito Campana, M.B.B.S., both of Mayo Clinic.

 

[NY Times Article] Risk Calculator for Cholesterol Appears Flawed

From the 17 November 2013 article at the NY Times

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with anonline calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

Dr. Nancy Cook and Dr. Paul M. Ridker of Harvard Medical School found that a new online calculator used to assess heart treatment options overestimated the risks that many people face.

The apparent problem prompted one leading cardiologist, a past president of the American College of Cardiology, to call on Sunday for a halt to the implementation of the new guidelines.

“It’s stunning,” said the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”

The controversy set off turmoil at the annual meeting of theAmerican Heart Association, which started this weekend in Dallas. After an emergency session on Saturday night, the two organizations that published the guidelines — the American Heart Association and the American College of Cardiology — said that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator.

Dr. Sidney Smith, the executive chairman of the guideline committee, said the associations would examine the flaws found in the calculator and determine if changes were needed. “We need to see if the concerns raised are substantive,” he said in a telephone interview on Sunday. “Do there need to be changes?”

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal.

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Related articles

• Does calculator overstate heart attack risk? (cnn.com)
• NYT: Risk calculator for cholesterol appears flawed (nbcnews.com)
• Experts Warn New Cholesterol Calculator Doesn’t Add Up (healthland.time.com)
• Cholesterol Math Doesn’t Add Up (healthland.time.com)
• Some Doctors Challenge New Statin Guidelines (news.health.com)
• Calculator may overstate heart attack risk (wyff4.com)