[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.

 

Some “Good” Cholesterol May Be Bad For Heart

Fr0m the 20 May 2012 article at Medical News Today

It appears that in some cases, high-density lipoprotein (HDL) cholesterol, the so-called “good” cholesterol, does not protect againstheart disease, and may even be harmful. A new study suggests a subclass of HDL that carries a particular protein is bad for the heart.

Previous studies have shown that high levels of HDL cholesterol are strongly linked to low risk of heart disease. But trials where people have been given drugs to increase their levels of HDL cholesterol have yielded inconsistent results: leading to the idea that HDL cholesterol may actually have protective and non-protective elements.

Now, researchers at the Harvard School of Public Health (HSPH) have found that when the surface of HDL cholesterol bears a small protein called apolipoprotein C-III (apoC-III), there is an increase in the risk of heart disease, and when it is absent, HDL cholesterol is especially heart protective….

Related articles

• HDL ‘Good Cholesterol’ Found Not to Cut Heart Risk – NYTimes.com (policyabcs.wordpress.com)
• ‘Good’ cholesterol’s heart benefits challenged (cbc.ca)
• Some ‘good’ cholesterol unable to protect heart (news.bioscholar.com)
• Will high HDL level lower the risk of heart attack? (thehindu.com)
• Some HDL, or ‘good’ cholesterol, may not protect against heart disease (eurekalert.org)
• “Good” HDL Cholesterol May Not Protect Heart After All, Study Suggests (wibw.com)
• HDL Won’t Protect Against Heart Disease, Says Study Proving ‘Good’ Cholesterol Is Wishful Thinking (blisstree.com)
• HDL ‘Good Cholesterol’ Found Not to Cut Heart Risk – NYTimes.com (fitnessgroan.me)
• ‘Good’ cholesterol doctrine may be flawed: study (news.yahoo.com)