U.S. Panel Backs Use of Cholesterol Lowering Drugs to Reduce Risk of Heart Attack

The federal government has published new cholesterol standards for the first time in eight years. The standards come from the National Cholesterol Education Program's expert committee on cholesterol. The group was appointed by the National Heart, Lung and Blood Institute, which is part of the National Institutes of Health. Many in the medical field are questioning the new standards since 5 of the committee's 14 members were consultants to, or received honorariums from some of the drug companies. There were 27 panel members who developed the guidelines, and more than 40 groups that reviewed and commented on the recommendations.

The recommendations would put about 18% of American adults on "statin" drugs like Pfizer's Lipitor, Merck's Zocor or Bristol-Myers Pravochol. Under the guidelines, anyone who already has coronary artery disease and whose LDL, or "bad" cholererol is above 130 generally should be on drug therapy. The new standards do not change the overall guidelines for total cholesterol: Above 240 is still considered high, 200 to 239 is considered borderline high and below 200 is considered desirable. The panel's new recommendations are that anyone whose LDL cholesterol level is over 190 should be on drug therapy. The recommendations are posted on the Web page of the institute at .

More than 1 million Americans have heart attacks each year and a half-million die from heart disease. The new recommendations would increase the number of Americans who are candidates for cholesterol-lowering drugs to about 36 million from the 13 million under the old guidelines. The panel's new recommendations introduces a formula that estimates an individual's chance of having a heart attack in the next 10 years. People with diabetes would be automatically put into the high risk category. Diet, exercise and weight reduction would be the primary recommendation for only low risk individuals. According to the new guidelines anyone who has had a heart attack would automatically be put onto the cholesterol lowering drug regimen.

The new formula calculates risk for men and women according to age, cholesterol level, smoking status and blood pressure. The panel urged that anyone whose risk was 20 % or more be treated as aggressively as patients who had just had a heart attack.Under the new standards HDL or "good" cholesterol below 40 is considered too low. Previously 35 was considered the cutoff point.

Research has shown that a fairly low percentage of people who are theoretically candidates for cholesterol lowering drug treatment actually undergo it. Many who start the drug treatment do not stick with it.


By Allan Rubin
posted June 6, 2001