Wednesday, November 20, 2013

Et Tu AHA?


This week the American Heart Association and American College of Cardiology issued new guidelines for determination of just who should be taking cholesterol lowering drugs commonly referred to "statins." The guidelines abandon a value based approached that begins with a patient's level of "bad" cholesterol, and rely soley upon online risk calculator's estimate of having a heart attack or stroke within the next 10 years. If the risk is >7.5%, treatment with statins is recommended. Mercifully, and perhaps sensing that something was not quite right form the beginning, the National Heart Lung and Blood Institute, the nation's cardiovascular disease research arm, declined to participate in the effort.

The new approach has been subject to immediate, scholarly and in this cardiologist's opinion, highly valid criticism that it substantially overestimates risk, and therefore, subjects millions of people to unnecessary drug therapy. As Dr Steven Nissen points out, the new approach virtually insures that every African American man above the age of 65  will be subject to treatment. In response to these alternative views, the poobahs have met in Dallas at this weeks AHA annual meeting. Ernest conversation no doubt has taken place. The result, predictably, is that he new guidelines will go forward as written. Too many reputations on the line no doubt.

So yet another American institution, this one deeply honored, diminished itself.


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