We're sorry, but this page is not available. Try typing the web address again, or using our search feature at the top of the page to find similar content. You may also be interested in learning more about: ||||| The new guidelines, formulated by the American Heart Association and the American College of Cardiology and based on a four-year review of the evidence, simplify the current complex, five-step process for evaluating who needs to take statins. In a significant departure, the new method also counts strokes as well as heart attacks in its risk calculations, a step that will probably make some additional people candidates for the drugs. 
 
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 It is not clear whether more or fewer people will end up taking the drugs under the new guidelines, experts said. Many women and African-Americans, who have a higher-than-average risk of stroke, may find themselves candidates for treatment, but others taking statins only to lower LDL cholesterol to target levels may no longer need them. 
 
 The previous guidelines put such a strong emphasis on lowering cholesterol levels by specific amounts that patients who did not hit their target levels just by taking statins often were prescribed additional drugs like Zetia, made by Merck. But the new guidelines say doctors should no longer prescribe those extra medicines because they have never been shown to prevent heart attacks or strokes. 
 
 Zetia has been viewed with increasing skepticism in recent years since studies showed it lowered LDL cholesterol but did not reduce the risk of cardiovascular disease or death. Still, it is among Merck’s top-selling drugs, earning $2.6 billion last year. Another drug, Vytorin, which combines Zetia with a statin, brought in $1.8 billion in 2012, according to company filings. And in May, Merck won approval for another drug, Liptruzet, which also contains the active ingredient in Zetia and a statin, a development that surprised many cardiologists because of questions about its effectiveness. 
 
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 The new guidelines are part of a package of recommendations to reduce the risk of heart attack and stroke that includes moderate exercise and a healthy diet. But its advice on cholesterol is the flash point, arousing the ire of critics who say the authors ignored evidence that did not come from gold-standard clinical trials and should also have counted less rigorous, but compelling, data. 
 
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 For example, Dr. Daniel J. Rader, the director of the preventive cardiovascular medicine and lipid clinic at the University of Pennsylvania, points to studies of people with genes giving them low LDL levels over a lifetime. Their heart attack rate is greatly reduced, he said, suggesting the benefits of long-term cholesterol reduction. 
 
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 Committee members counter his view, saying that cholesterol lowered by drugs may not have the same effect. 
 
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 Critics also question the use of a 10-year risk of heart attack or stroke as the measure for determining who should be treated. Many people will have a lower risk simply because they are younger, yet could benefit from taking statins for decades to keep their cholesterol levels low, they say. 
 
 Dr. Rader and other experts also worry that without the goad of target numbers, patients and their doctors will lose motivation to control cholesterol levels. 
 
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 Experts say it is still unclear how much the new guidelines will change clinical practice. Dr. Rader suspects many cardiologists will still strive for the old LDL targets, at least for patients with heart disease who are at high risk. “They are used to it and believe in it,” he said. 
 
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 Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic, said he thought it would take years for doctors to change their practices. 
 
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 The process of developing the guidelines was rocky, taking at least twice as long as in the past. The National Heart, Lung and Blood Institute dropped out, saying that drafting guidelines was no longer part of its mission. Several committee members, including Dr. Rader, also dropped out, unhappy with the direction the committee was going. 
 
 The architects of the guidelines say their recommendations are based on the best available evidence. Large clinical trials have consistently shown that statins reduce the risk of heart attacks and strokes, but the committee concluded that there is no evidence that hitting specific cholesterol targets makes a difference. No one has ever asked in a rigorous study if a person’s risk is lower with an LDL of 70 than 90 or 100, for example. 
 
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 Dr. Neil J. Stone, the chairman of the committee and a professor of preventive cardiology at Northwestern University’s Feinberg School of Medicine, said he was surprised by what the group discovered as it delved into the evidence. “We deliberated for several years,” he said, “and could not come up with solid evidence for targets.” 
 
 Dr. Nissen, who was not a member of the committee, agreed. “The science was never there” for the LDL targets, he said. Past committees “made them up out of thin air,” he added. 
 
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 The Department of Veterans Affairs conducted its own independent review and came to the same conclusion. About a year ago, the department, the nation’s largest integrated health care system, dropped its LDL targets, said Dr. John Rumsfeld, the V.A.'s national director of cardiology. 
 
 “It is a shift,” he acknowledged, “but I would argue that it is not a radical change but is a course correction.” 
 
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 Dr. Paul M. Ridker, the director of the center for cardiovascular disease prevention at Brigham and Women’s Hospital, in Boston, said he worried the new guidelines could easily lead to overtreatment. An older man with a low LDL level who smokes and has moderately elevated blood pressure would qualify for a statin under the new guidelines. But what he really needs is to stop smoking and get his blood pressure under control. 
 
 Dr. Stone said he hoped doctors would not reflexively prescribe a statin to such a patient. Doctors are supposed to talk to their patients and realize that, with a man like the one Dr. Ridker described, the real problem was not cholesterol. 
 
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 “We are taking people out of their comfort zone,” Dr. Stone said. “Instead of being reassured that reaching this number means they will be fine, we are asking, ‘What is the best therapy to do the job?’ ” ||||| Skip in Skip x Embed x Share The American Heart Association and American College of Cardiology have released new guidelines today to try and prevent heart attacks and strokes. They focus on cholesterol-lowering statin drugs, a new way to assess risk and a healthy lifestyle. (No AP 
 
 The updated recommendations for treating cholesterol are "a huge, huge departure" from doctors' usual procedure. 
 
 People take the statin Lipitor for lowering blood cholesterol. (Photo: Mel Evans, AP) Story Highlights According to the new criteria, 31% of adults are good candidates for statins, compared with 15.5% now 
 
 Some experts worry about exposing more people to statins' side effects, including higher risk of diabetes 
 
 The guidelines eliminate benchmark numbers for cholesterol readings 
 
 Twice as many Americans will be eligible for cholesterol-lowering drugs, based on controversial new heart guidelines from two of the USA's leading cardiovascular associations. 
 
 The number of adults considered likely to benefit from statins will rise from about 15.5% today to 31%, according to the new criteria, developed by the American College of Cardiology and the American Heart Association, in collaboration with the National Heart, Lung and Blood Institute. While statins have been widely prescribed to reduce the risk of heart attacks, the new guidelines recommend that they also be considered for people at high risk of stroke. 
 
 STORY: New guidelines for treating obesity, too 
 
 That advice could lead doctors to prescribe statins to millions more people, says Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, who wasn't involved in the new guidelines. 
 
 "It's going to cause a huge conversation," says Mariell Jessup, president of the heart association. "It may be very controversial — which is fine. Controversy means discussion." 
 
 Authors of the new guidelines say they hope to get statins to more patients who need them, while avoiding unnecessary prescriptions for people unlikely to benefit. 
 
 The guidelines also call for doctors to work closely with patients to improve their diets and increase exercise. 
 
 Rita Redberg, a professor at the University of California-San Francisco, says she is concerned about exposing more patients to statins' side effects, which include an increased risk of diabetes, as well as muscle pain. 
 
 The average patient is likely to notice two major changes in the way that doctors manage their cholesterol, experts say. 
 
 For years, doctors often prescribed statins based on patients' cholesterol levels, especially their LDL, known as "bad" cholesterol. The new guidelines advise doctors to base their decisions on a patient's overall risk, rather than just their cholesterol. Nissen notes that even patients with normal cholesterol can have heart attacks. 
 
 "It's a huge, huge departure from the way that people have been thinking about cholesterol and heart disease," says Harlan Krumholz, a professor at the Yale School of Medicine. "Doctors today are obsessed with numbers." 
 
 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. 
 
 These changes will help doctors to focus not just on "lab values," but on the whole patient, including a patient's weight, blood pressure, use of tobacco, diet, physical activity and other considerations, Krumholz says. 
 
 Doctors have focused heavily in recent years on using drugs to reduce LDL to certain benchmark levels: under 130 for most people; 100 for people at high-risk; under 70 for those at the highest risk, such as those who have just survived a heart attack. Doctors have raised or lowered medication doses to help patients meet these targets, Nissen says. 
 
 The new guidelines get rid of these targets, says Carl Orringer, a cardiologist at University Hospitals Case Medical Center in Cleveland. Instead, doctors are encouraged to put patients on doses proven to work. 
 
 The expert panel decided to eliminate these benchmarks because no one has ever tested them in a randomized, controlled trial — the gold standard for medical evidence, Nissen says. While studies clearly show that lower LDL is better, there's really no data to support using one cutoff or another. 
 
 Getting doctors to change their practices could be difficult, Nissen says. 
 
 That's because numbers are easy to understand, both for busy physicians and patients without a medical background. Having a "target" cholesterol in mind has seemed helpful to many doctors and patients, because it has given them goals to work toward. 
 
 About 600,000 Americans die from heart disease every year, according to the Centers for Disease Control and Prevention. 
 
 Contributing: Nanci Hellmich 
 
 Read or Share this story: http://usat.ly/1ckPEiz ||||| The nation's first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans _ one-third of all adults _ to consider taking cholesterol-lowering statin drugs. 
 
 FILE - This undated photo provided by by Watson Pharmaceuticals Inc., shows Atorvastatin Calcium tablets, a generic form of Lipitor, which is being sold under a deal with Pfizer. The nation's first new... (Associated Press) 
 
 The guidelines, issued Tuesday by the American Heart Association and American College of Cardiology, are a big change. They use a new formula for estimating someone's risk that includes many factors besides cholesterol, the main focus now. They take aim at strokes, not just heart attacks. And they set a lower threshold for using medicines to reduce risk. 
 
 The definition of high cholesterol isn't changing, but the treatment goal is. Instead of aiming for a specific number, using whatever drugs get a patient there, the advice stresses statins such as Lipitor and Zocor and identifies four groups of people they help the most. 
 
 "The emphasis is to try to treat more appropriately," said Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel. "We're going to give statins to those who are the most likely to benefit." 
 
 Doctors say the new approach will limit how many people with low heart risks are put on statins simply because of a cholesterol number. Yet under the new advice, 33 million Americans _ 44 percent of men and 22 percent of women _ would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of adults. 
 
 Some doctors not involved in writing the guidance worry that it will be tough to understand. 
 
 "It will be controversial, there's no question about it. For as long as I remember, we've told physicians and patients we should treat their cholesterol to certain goal levels," said the Cleveland Clinic's Dr. Steven Nissen. "There is concern that there will be a lot of confusion about what to do." 
 
 The government's National Heart, Lung and Blood Institute appointed expert panels to write the new guidelines in 2008, but in June said it would leave drafting them to the Heart Association and College of Cardiology. New guidelines on lifestyle and obesity also came out Tuesday, and ones on blood pressure are coming soon. 
 
 Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations. 
 
 "It is practically impossible to find a large group of outside experts in the field who have no relationships to industry," said Dr. George Mensah of the heart institute. He called the guidelines "a very important step forward" based on solid evidence, and said the public should trust them. 
 
 Heart disease is the leading cause of death worldwide. High cholesterol leads to hardened arteries that can cause a heart attack or stroke. Most cholesterol is made by the liver, so diet changes have a limited effect on it. 
 
 Millions of Americans take statins, which reduce cholesterol dramatically and have other effects that more broadly lower the chances of heart trouble. 
 
 The patents on Lipitor, Zocor and other statins have expired, and they are widely available in generic versions for as little as a dime a day. One that is still under patent protection is AstraZeneca's Crestor, which had sales of $8.3 billion in 2012. 
 
 Despite a small increased risk of muscle problems and accelerating diabetes in patients already at risk for it, statins are "remarkably safe drugs" whose benefits outweigh their risks, said Dr. Donald Lloyd-Jones, preventive-medicine chief at Northwestern. 
 
 Current guidelines say total cholesterol should be under 200, and LDL, or "bad cholesterol," under l00. Other drugs such as niacin and fibrates are sometimes added to statins to try to reach those goals, but studies show they don't always lower the chances of heart problems. 
 
 "Chasing numbers can lead us to using drugs that haven't been proven to help patients. You can make someone's lab test look better without making them better," said Yale University cardiologist Dr. Harlan Krumholz, who has long urged the broader risk approach the new guidelines take. 
 
 They say statins do the most good for: 
 
 _People who already have heart disease. 
 
 _Those with LDL of 190 or higher, usually because of genetic risk. 
 
 _People ages 40 to 75 with Type 2 diabetes. 
 
 _People ages 40 to 75 who have an estimated 10-year risk of heart disease of 7.5 percent or higher, based on the new formula. (This means that for every 100 people with a similar risk profile, seven or eight would have a heart attack or stroke within 10 years.) 
 
 Aspirin _ widely used to lower the risk of strokes and heart attacks _ is not addressed in the guidelines. And many drugs other than statins are still recommended for certain people, such as those with high triglycerides. 
 
 Patients should not stop taking any heart drug without first checking with their doctor. 
 
 The guidelines also say: 
 
 _Adults 40 to 79 should get an estimate every four to six years of their chances of suffering a heart attack or stroke over the next decade using the new formula. It includes age, sex, race, cholesterol, blood pressure, diabetes and smoking. If risk remains unclear, doctors can consider family history or three other tests. The best one is a coronary artery calcium test, an X-ray to measure calcium in heart arteries. 
 
 _For those 20 to 59, an estimate of their lifetime risk of a heart attack or stroke can be considered using traditional factors like cholesterol and blood pressure to persuade them to change their lifestyle. 
 
 _To fight obesity, doctors should develop individualized weight loss plans including a moderately reduced calorie diet, exercise and behavior strategies. The best ones offer two or three in-person meetings a month for at least six months. Web or phone-based programs are a less-ideal option. 
 
 _Everyone should get at least 40 minutes of moderate to vigorous exercise three or four times a week. 
 
 _People should eat a "dietary pattern" focused on vegetables, fruits and whole grains. Include low-fat dairy products, poultry, fish, beans and healthy oils and nuts. Limit sweets, sweet drinks, red meat, saturated fat and salt. 
 
 "I don't like the concept of `good foods' and `bad foods,'" said Dr. Robert Eckel, a University of Colorado cardiologist who worked on the guidelines. "We really want to emphasize dietary patterns." 
 
 ___ 
 
 Online: 
 
 Risk formula: http://my.americanheart.org/cvriskcalculator 
 
 Guidelines on cholesterol: http://bit.ly/1j2hDpH 
 
 Lifestyle: http://bit.ly/16ZnV7e 
 
 Overweight: http://bit.ly/1bsdFG2 
 
 Risk Assessment: http://bit.ly/19hzaV9 
 
 Cholesterol info: http://tinyurl.com/2dtc5vy 
 
 Heart facts: http://circ.ahajournals.org/content/127/1/e6 
 
 ___ 
 
 Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP ||||| Story highlights New guidelines could double the number of folks eligible for medication, experts say 
 
 These guidelines call for a focus on risk factors, not just cholesterol levels 
 
 The policy say it's important how patients lower "bad" cholesterol 
 
 If you're not on medicine to lower your cholesterol yet, you might be soon. 
 
 In what's being called a tectonic shift in the way doctors will treat high cholesterol, the American Heart Association and the American College of Cardiology on Tuesday released new treatment guidelines calling for a focus on risk factors rather than just cholesterol levels. 
 
 The new guidelines could double the amount of people on medication to lower their cholesterol, experts say. 
 
 "This is an enormous shift in policy as it relates to who should be treated for high levels of cholesterol," said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. 
 
 The biggest change from the old guidelines, he says: Ignore the numbers. 
 
 "For many years, the goal was to get the 'bad' cholesterol levels -- or LDL levels -- below 100," Nissen said. "Those targets have been completely eliminated in the new guidelines, and the threshold for treatment has been eliminated." 
 
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 In their place, the guidelines suggest using specific risk factors to determine who should be treated with cholesterol-lowering statin drugs, and who should simply make lifestyle changes. 
 
 Among the four questions to ask to determine risks: Do you have heart disease? Do you have diabetes (Type 1 or 2)? Do you have a bad cholesterol level more than 190? And is your 10-year risk of a heart attack greater than 7.5%? 
 
 According to the new guidelines, if you answered yes to any of those four questions, you should be on a statin. Period. 
 
 New drugs could drop cholesterol to extreme lows 
 
 For those who do not fit those criteria, the committee behind the new policy says lifestyle and behavior management should be sufficient to help manage high cholesterol. 
 
 "The focus for years has been on getting the LDL low," said Dr. Neil Stone, committee chairman. 
 
 "Our guidelines are not against that. We're simply saying how you get the LDL low is important. Considering all the possible treatments, we recommend a heart-healthy lifestyle and statin therapy for the best chance of reducing your risk of stroke or heart attack in the next 10 years." 
 
 Calculating risks 
 
 So how do you and your doctor determine if your 10-year risk of a heart attack is above 7.5% and you should be put on a statin? 
 
 A simple calculation, said Dr. Donald Lloyd-Jones, chairman of the committee that developed the equation. 
 
 "We were able to generate very robust risk equations for both non-Hispanic white men and women as well as African-American men and women," Lloyd-Jones said. "Those equations factor in age, sex, race, total and HDL ('good') cholesterol levels, blood pressure levels, blood pressure treatment status as well as diabetes and current smoking status." 
 
 Each of those factors is assigned a numerical value and can be used to determine individual risk percentage using an online calculator. 
 
 The hope, Lloyd-Jones said, is that by doing these calculations, patients can be more informed about their risks when going to see doctors. 
 
 "The greatest strength behind these guidelines is that they hit at the heart of prevention -- which is that lifestyle, rather than treating isolated risk factors, is the key to reducing risk of chronic disease," said Dr. Sharon Horesh Bergquist, an assistant professor of medicine at Emory University, in an e-mail. 
 
 "We tend to focus on 'quick fix' answers such as a pill ... whereas the risk reduction from lifestyle changes, such (as) exercise three-four days a week, reduces risk nearly double to that from any one of the medication interventions." 
 
 Double the prescriptions 
 
 By changing the way doctors evaluate a patient for statin therapy, Nissen said these new guidelines will effectively double the number of Americans eligible for statin therapy, bringing the total to about 72 million. 
 
 How to boost your 'good' cholesterol 
 
 So does this mean big bucks for the pharmaceutical companies? Nissen said no -- and in fact, it may mean a downturn in their business. 
 
 "Now, except for Crestor, they're virtually all generic -- you can get a three-month supply for $10," he said. "So there's really no money to be made with statins anymore." 
 
 He goes on to say that while prescriptions for these drugs will increase dramatically, the guidelines all but shunned other cholesterol-lowering drugs such as Zetia, a big moneymaker for Merck & Co. 
 
 Aside from the financial aspects of medicating 35 million more Americans, using statins in a much broader population has been controversial. 
 
 Some people, such as cancer expert Dr. David Agus, advocate giving everyone older than 45 a statin, due both to cholesterol-lowering properties and potential benefit in reducing cancer. 
 
 Others say that with the potential side effects from statin use -- muscle pains and soreness, a potential moderate increase in liver disease and a risk for developing Type 2 diabetes -- they should be used with care. 
 
 Nissen, who strongly disagrees with Agus' suggestion on statins, said a measured approach is best. 
 
 "If you have a young woman who is otherwise healthy, giving (her) a statin doesn't make any sense at all," Nissen said. "I do believe the evidence is solid that if you have risk, that statins are enormously beneficial." 
 
 Other recommendations 
 
 In addition to the guidelines on evaluating cholesterol risk, the American Heart Association and American College of Cardiology released two other sets of guidelines relating to overall heart health. 
 
 One report gives guidelines for eating a heart-healthy diet, including reducing saturated and trans fats as well as limiting sodium to 2,400 milligrams per day -- 30% less than the average American consumes on a daily basis. 
 
 Cholesterol levels: What numbers should you aim for? 
 
 The other report dealt with treatment guidelines for physicians on managing weight loss in their patients. They include a call to create individualized weight loss plans and recommend counseling with a dietitian or other certified weight loss professional for at least six months. 
 
 That report also goes on to suggest that doctors should begin offering bariatric surgery as a potentially viable option to improve health for patients with a body mass index over 40, or those with a BMI over 35 and other complicating factors.
– Two leading heart groups have announced changes being described as "tectonic" and "profound" in the way doctors prescribe cholesterol-lowering statins. The shift from the American Heart Association and the American College of Cardiology means that doctors will no longer focus on a patent's level of "bad cholesterol"—or LDL— and automatically prescribe statins when it reaches a certain level. Instead, they will focus on a range of overall health factors. "This is an enormous shift in policy as it relates to who should be treated for high levels of cholesterol," the chief of cardiovascular medicine at the Cleveland Clinic tells CNN. "For many years, the goal was to get the 'bad' cholesterol levels—or LDL levels—below 100," says Dr. Steven Nissen. "Those targets have been completely eliminated in the new guidelines, and the threshold for treatment has been eliminated." So who will be taking statins? People who have a history of heart trouble or diabetes, and—in the one exception to the notion of ignoring LDL levels—those who have dangerously high levels of 190 or more, reports the New York Times. Beyond that, the guidelines say anyone who has a 7.5% risk of developing heart disease, based on a new formula (the site is slow, apparently bogged down) also should take them, reports USA Today. In yet another major shift, the guidelines now apply to people at risk of stroke as well as a heart attack, reports AP. That change alone could double the number of people on the drugs, which are currently prescribed to 25% of Americans older than 40.