2013 AHA/ACC Cardiovascular Risk Reduction Guidelines - Drug Companies Win Again

Last week the American Heart Association (AHA) and the American College of Cardiology (ACC) published new updated guidelines in the journalCirculation for reducing the risk of cardiovascular disease in individuals [1]. Their goals aim to “prevent cardiovascular (CV) diseases, improve the management of people who have these diseases through professional education and research, and develop guidelines, standards and policies that promote optimal patient care and cardiovascular health“.

To accomplish these commendable goals, AHA/ACC targets better management of blood cholesterol levels, overweight and obesity in adults, and provides information on lifestyle modifications [2]. They also provide extensive guidelines on the use of cholesterol-lowering medications, mainly the statins [1].

After reading through the updated guidelines it is clear to me that the state of cardiovascular health, as it stands currently in the United States today, will remain dismal at best. The chance of heart disease and strokes being displaced as the number one and number four leading causes of death in the U.S. [3] are slim to none. Here’s why…
 

THE REAL FACTS ON CARDIOVASCULAR DISEASE

Cardiovascular disease is heavily predicted by the presence of hypercholesterolemia (i.e. high cholesterol), which leads to atherosclerosis. Animal and human studies have long shown that symptomatic and fatal atherosclerotic disease are extremely rare, if not completely absent, when total cholesterol levels are < 150 mg/dL and LDL (bad) cholesterol levels are < 100 mg/dL [4,5]. In other words, if your cholesterol numbers fall below those marks the chance of you having a heart attack, stroke, or dying from cardiovascular disease are next to ZERO!
 

WHAT DO THE NEW AHA/ACC GUIDELINES SAY?

The new AHA/ACC guidelines dismiss the above facts completely. Instead, they base their recommendations to treat people with statin drugs for potential and actual cardiovascular disease to one of the following ‘high-risk’ groups:

1) Those with clinical cardiovascular disease
2) Those with elevated LDL cholesterol of > or = 190 mg/dL
3) Diabetics (age 40-75) without clinical cardiovascular disease and with LDL levels between 70-189 mg/dL
4) Healthy individuals (age 40-75) with LDL levels 70-189 mg/dL with an estimated 10-year atherosclerotic cardiovascular disease risk of > or = 7.5%

(You can calculate your 10-year cardiovascular disease risk here or HERE using the same formula these guidelines use. But beware! There is already known problems with this calculator. Two Harvard Medical School professors have independently reviewed it’s future risk calculations and compared it to actual historical data of patients suffering heart attacks and strokes, and they’ve found it to overestimate a person’s risk by 75%-150%!)

These differ greatly from previous guidelines by the National Cholesterol Education Panel (NCEP),  which were all about targeting specific cholesterol levels. In the past, those with known heart disease were told to reduce their LDL cholesterol to 70 mg/dL or below and those without heart disease were told to reduce LDL to 100 mg/dL or below.

‘Know your numbers’ has been the gold standard for years. However, a major change has now happened with the new guidelines. The notion of ‘know your numbers‘ gets thrown right out the window, despite proof that lowering your cholesterol levels to the levels talked about earlier virtually eliminates heart disease. Instead, the new guidelines will effectively double the amount of patients who are now viable candidates for the multi-billion dollar pharmaceutical industry. According to the National Institutes of Health, up to 30% of the adult population will now be candidates for statin therapy with the implementation of these new guidelines.

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