Cholesterol guidelines get an update

Federal guidelines on the management of patients' cholesterol levels have been broadened to include more intensive treatment for patients at risk for a heart attack, potentially adding millions more to those already taking statin drugs.

The update is based on the conclusions of five recent clinical trials that examined the role played by low-density lipoprotein cholesterol in heart attacks. "The recent trials add to the evidence that when it comes to LDL cholesterol, lower is better for persons with high risk for heart attack," said Barbara Alving, MD, acting director of the National Heart, Lung and Blood Institute.

The changes were made as an update to the National Cholesterol Education Program's clinical practice guidelines of 2001 and were published in the July 13 issue of Circulation.

Among the changes:

• A treatment option was added for lowering LDL cholesterol to below 70 mg/dL for patients at very high risk for a heart attack. For high-risk patients, the overall goal remains at an LDL level of less than 100 mg/dL.
• A treatment option was added for lowering LDL cholesterol to below 100 mg/dL for patients at moderately high risk for a heart attack. An option was also added to use drug therapy if LDL is 100-129 mg/dL.
• A recommendation that drug therapy be sufficient to achieve at least a 30% to 40% reduction in LDL levels.
• Lifestyle changes should be recommended for patients at high or moderately high risk with lifestyle-related risk factors, including smoking, diabetes or metabolic syndrome (obesity, high triglycerides and low HDL) regardless of their LDL levels.

The updates should not be considered the final word on LDL goals, said James Cleeman, MD, coordinator of the clinical guidelines. Three ongoing trials could lead to even broader recommendations.

The NHLBI, American College of Cardiology and American Heart Assn. endorsed the update.