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House calls are meant for patients who are temporarily or permanently home bound, or for other good reasons can't make it into the office.

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Wednesday, March 26, 2014

Cholesterol News, Again?

In November 2013, the American  Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for cholesterol therapy in adults 20-79 years old. The guidelines were based on solid medical evidence but, nonetheless, generated a lot of controversy and even opposing opinions from experts in the field. On one hand, the guidelines argue for limiting some of the cholesterol testing we now use as a guide for therapy. On the other hand, the guidelines recommend therapy (the use of statin drugs) for certain groups of patients, regardless of their blood cholesterol levels. The controversy which evolved was covered in articles in the New York Times last November. The two titles convey the opposing messages: Experts Reshape Treatment Guide for Cholesterol and Don’t Give More Patients Statins.

Some of the best known statin drugs now in use include: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Lovastatin and Simvastatin.

A study on the subject was published in the New England Journal of Medicine of  3/20/2014 by Michael J. Pencina, PhD, from the Duke Clinical Research Institute. It reports that the new guidelines would increase the number of U.S. adults eligible for statin therapy by almost 13 million, and that most adults between 60-75 years old would become candidates for treatment. I also refer to the guidelines in my blog of last November, Statins, To Take Or Not To Take.

The guidelines use a newly updated, computerized cardiac risk assessment tool, in deriving its recommendations. We use the same tool in our office.

 One has to remember that the guidelines are guidelines; they are not iron clad rules. Each case has to be judged individually. In the majority of cases, the guidelines should be followed. But there are exceptions. A small percentage of people just can’t take statins because of side effects. Others may be able to make lifestyle changes, such as diet modification, an increase in physical activity and weight loss, which may mitigate against the ill effects of high cholesterol. Others may have to be convinced that the benefits of taking a statin outweigh the risks. Still others may have to be convinced that they actually already have the beginnings of heart disease before they agree to take the medication. And then there is that group of patients that “just get away with high cholesterol.” Their families have had high cholesterol for generations, and they live well into their nineties or longer. They are the ones who wouldn't hear of statins…

When necessary, additional testing is done to further assess you heart disease risk, such as specialty blood work, and coronary artery calcium scoring.

So next time you’re in the office, ask about the new cardiac risk assessment (it’s free), and see if you really need to take a statin drug.

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