Earlier this month, the American Heart Association (AHA) and the American College of Cardiology (ACC) published new guidelines on how to treat high cholesterol in adults, specifically with the goal of reducing atherosclerotic cardiovascular risk.  Prior to publication, the AHA and the ACC solicited comments from physicians and specialists in the field. The Boston Globe reports that among those asked to comment in the summer of 2012 were researchers from Brigham and Women’s Hospital.  In response, they provided a critique of the new guidelines.  Of particular concern to them was the fact that it overestimated the patients’ chances of getting sick.

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.  This echoes the concerns of the critique provided by the researchers, but was not resolved in the published version of the guidelines.

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.

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.

After publications, Brigham cardiologist Paul Ridker provided a public, scathing critique and launched a high-profile assault on the risk assessment tool.  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.  In response to the critics, AHA has remained strong and continues to defend the new guidelines.