The American Heart Association (AHA) and the American College of Cardiology (ACC) have published new guidelines on how to treat high cholesterol in adults, specifically with the goal of reducing atherosclerotic cardiovascular risk.  According to USA Today, the guidelines have been controversial because, under its recommendations, twice as many Americans will be eligible for statins, which are cholesterol-lowering drugs.  The number of adults considered likely to benefit from statins will rise from about 15.5% today to 31%, according to the new criteria, under these new criteria.

However, the guidelines emphasize the importance of behavioral and lifestyle factors.  Modifications such as adhering to a heart healthy diet, regular exercise habits, avoidance of tobacco products, and maintenance of a healthy weight are critical components of health promotion and cardiovascular risk reduction, both prior to and in conjunction with the use of statin drug therapies.  The AHA and the ACC have also issued a joint report with specific guidelines for lifestyle modification.

The new cholesterol treatment guidelines depart from the traditional method of using cholesterol, specifically LDL or “bad” cholesterol, to determine who needs pharmaceutical intervention.  Now, doctors are advised to base their decisions on a patient’s overall risk.  Given that even individuals with a normal cholesterol level can have heart attacks, other criteria need to be considered in treating and preventing cardiovascular disease.

The guidelines identify four high-risk groups who could benefit from statins: people with pre-existing heart disease, such as those who have had a heart attack; people ages 40 to 75 who have diabetes; patients ages 40 to 75 with at least a 7.5% risk of developing cardiovascular disease over the next decade, according to a formula described in the guidelines; and patients with the sort of super-high cholesterol that sometimes runs in families, as evidenced by an LDL of 190 milligrams per deciliter or higher.

While some medical professionals consider the new guidelines to be controversial, they have the support of other professionals in the cardiovascular field.  The guidelines have been officially endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, American Pharmacists Association, American Society for Preventive Cardiology, Association of Black Cardiologists, Preventive Cardiovascular Nurses Association, and WomenHeart: The National Coalition for Women with Heart Disease.

AHA and ACC work on a number of joint guidelines together.  In addition to these, in 2013 they worked with the Obesity Society to issue the “Guideline for the Management of Overweight and Obesity in Adults.”  They also issued a general guideline for assessing cardiovascular risk.