New Cholesterol Guidelines Shift Away from 'Statins'
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New cholesterol guidelines shift away from statins
by Loren Bonner of PharmacyTimes
September 16, 2014New recommendations about cholesterol were announced by the National Lipid Association (NLA) that focus on patient-centered ways to reduce and prevent cardiovascular events where patients and providers will work more collaboratively.
The recommendations, which were published in the Journal of Clinical Lipidology and grounded in advice from a panel of independent experts, emphasize a more comprehensive measure of cholesterol-related risk based on atherogenic cholesterol, which is known to contribute to most arteriosclerotic cardiovascular disease (ASCVD) events.
“The primary focus of these guidelines is on the treatment of non-HDL cholesterol and the treatment goals in contrast to the recent American Heart Association [AHA] and American College of Cardiology [ACC] guidelines, which advocate for statins to treat heart disease,” said Scott Grundy, MD, PhD, Professor in the Department of Internal Medicine at the University of Texas Southwestern Medical Center and one of the members of the NLA expert panel that developed the recommendations.
The NLA expert panel concluded that non-HDL-C should be considered a cotarget with LDL-C because “non-HDL-C now looks to be a better primary target for modification than LDL-C.”
The study authors wrote that non-HDL-C comprises the cholesterol carried by all potentially atherogenic particles, including LDL, intermediate density lipoproteins, very low-density lipoproteins (VLDL) and VLDL remnant, chylomicron remnants, and lipoprotein.
Non-HDL-C and LDL-C, both B-containing lipoproteins, also known as atherogenic cholesterol, are considered the root cause of atherosclerosis.
"The new NLA recommendations are targeted at health care providers to help patients better understand their treatment options, reduce cardiovascular risk, and set actionable and attainable goals for treatment," said Terry A. Jacobson, MD, President of the National Lipid Association and Professor of Medicine at Emory University, in an official statement. "The panel emphasizes that patients and providers working in partnership to achieve mutually agreed-upon cholesterol and lifestyle goals will equip patients with the metrics of success needed to prevent and reduce cardiovascular events."
The recommendations are intended to be a “modest refinement” of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) Guidelines, as well as what the AHA and ACC have put forth in efforts to update ATP III.
The cholesterol treatment guideline from AHA and ACC, released last November and endorsed by APhA, focus on identifying which groups of patients need statin therapy and how much. A main criticism of the guideline was that the risk calculator it established overestimated risk and could skew the number of patients who should be receiving statin therapy.
Grundy said the NLA guideline is fundamentally different from the AHA–ACC guideline, not only in what it states, but also because the AHA–ACC guidelines relied solely on information from randomized controlled trials. NLA’s approach was done in a more integrated fashion using clinical trial results, epidemiology, and more.
“I think they allow for more flexibility for lowering cholesterol in contrast to the new AHA–ACC guideline,” said Grundy.
NLA said it hopes the new recommendations will help supplement existing gaps in current guidelines.
