University of Iowa professor helped draft new cholesterol guidelines

State-of-the-art testing will replace previous guidelines established 10 years ago

March 28, 2014 | 11:29 pm

When new national guidelines on heart health and cholesterol were released this week, University of Iowa professor Jennifer Robinson felt a sense of accomplishment – and a little exhausted.

“We worked so hard,” said Robinson, an expert in epidemiology and cardiology. “It’s nice to have this out there for people to begin using.”

Robinson served as vice chair for the cholesterol guidelines expert panel convened in 2008 to review the previous recommendations, and she told The Gazette this week that said her group conducted a rigorous systematic review in updating the guidelines.

What they came up with moves away from using targets for lowering bad LDL cholesterol levels and instead looks at patient risk levels in advising the use of cholesterol-lower statin drugs. The change could double the number of people on the medication, and it could increase the dosing for some, according to Robinson.

The new recommendations – announced by the American College of Cardiology and American Heart Association – are geared toward two broad categories of people needing statin treatment: those with extremely high levels of bad cholesterol and those at risk of having a heart attack or stroke for other reasons.

The committee found that people in both groups benefit greatly from statin treatment, and it advised them to use therapy without focusing on lowering bad cholesterol to a target level, said Robinson.

“What happens when you do that is you treat people with statin based on risk rather than getting your LDL to a certain level,” Robinson said. “It’s a change, but it’s actually easier to do.”

At-risk individuals include those who have survived a heart attack or stroke or have them in their family history. Doctors also can assess a person’s risk using a new calculator that factors in blood pressure, age, weight and total cholesterol levels.

The previous guidelines were established 10 years ago based on a limited number of clinical trials, according to Robinson. Since then, she said, researchers have conducted dozens more trials and offered up additional evidence for how to reduce heart attacks and strokes.

“We did a state of the art review, and we came up with a different conclusion,” Robinson said. “And we are excited that this is based on strong science. There is no guessing here. There is a huge amount of evidence.”

Robinson said evidence backing the recommendations is so solid that the committee also can say with confidence that benefits of the drugs outweigh the risks for all categories of at-risk individuals.

“Even if we pick the worst-case scenario of how safe statins are … they still had a large net benefit,” Robinson said. “The benefit from reducing the chance of a heart attack or stroke outweighs any chance for harm.”

Practitioners also now are being advised to re-evaluate dosing in some cases – perhaps increasing it above what would have been recommended in the past.

“It’s the dosing and risk factors that matter,” Robinson said.

The new recommendations, which cardiologists and primary care physicians likely will follow, could double the number of Americans taking statin drugs, Robinson said. That, in part, is because the new research urges people with risk factors but low cholesterol levels to take the medication.

“They never would have been treated before, but they still benefit,” Robinson said.

Experts estimate the new guidelines could bump the percent of people taking statin drugs up from 15 percent to 30 percent.

Robinson said practitioners might have preferred to treat more people in the past, but the medication was too expensive. That is not the case today, as patents on some drugs are expiring and generic versions are becoming available.

“The cost is not an issue any more,” Robinson said. “So let’s have a different conversation about trying to prevent heart attacks and strokes in Americans.”

Some practitioners and field experts have expressed concern about the new guidelines, saying they are confusing and too different from the previous number-centered cholesterol advice. Robinson acknowledged that challenge, but said she thinks the committee managed to streamline the recommendations.

“We tried to make it as simple as possible – even simpler and easier for doctors and patients to understand,” she said.

The panel still stresses a healthy diet and exercise as key in avoiding heart problems. And, officials said, research will continue and the guidelines will be updated again.

“Some data suggests that we might not need to treat people their whole lives with statin,” Robinson said. “But that is an area for future research.”

Reuters contributed to this report.

 

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