November 19, 2013
Controversy Brews Over AHA’s Statins Recommendations
Brett Smith for redOrbit.com - Your Universe Online
Last week, the American Heart Association (AHA) and the American College of Cardiology (ACC) made significant waves when they released a set of recommendations for healthcare providers that suggested 33 million more Americans could benefit from cholesterol-lowering drugs called statins.
This week, those recommendations are being called into question as a pair of Harvard Medical School professors published a report in the journal The Lancet that said the guidelines are based on flawed calculations.
“It’s stunning,” cardiologist Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, told the New York Times. “We need a pause to further evaluate this approach before it is implemented on a widespread basis.”
Dr. Donald Lloyd-Jones, a cardiologist and chairman of the department of preventive medicine at Northwestern University, told USA Today he stands by the recommendations he helped to write, but said they would be updated over time.
"These aren't set in stone. As more high-quality research becomes available, we will incorporate it into the guidelines to improve patient care," Lloyd-Jones said.
The conflict comes as the AHA is holding its annual meeting in Dallas this week. After a Saturday night meeting, the AHA and the ACC both said the calculator used to generate the recommendations was not perfect, yet it was a major step forward, and noted patients and doctors should discuss treatment options – not simply follow a calculator.
Dr. Paul M. Ridker and Dr. Nancy Cook, the Harvard authors of the Lancet article, had raised doubts a year earlier upon receiving an early draft from the National Institutes of Health, which originally was formulating the recommendations. Both Harvard doctors had said the calculator in question was not working correctly.
Dr. Michael Blaha, director of clinical research at Johns Hopkins University who was not involved in developing the new guidelines, told the New York Times the calculator’s problem might be due to the fact it is based on data collected more than ten years ago, when strokes and heart attacks tended to occur earlier in life.
Many relevant habits, such as smoking, have changed within the general population over the past decade, Blaha noted. “The cohorts were from a different era,” the Johns Hopkins researcher said.
The new guidelines are a major change from the existing recommendations released in 2002, which said patients should only be prescribed a statin if their 10-year risk level was above 20 percent. While the old guidelines only included risk for heart disease, the new recommendations now consider a patient’s risk for stroke.
“These new guidelines represent the best of what scientific research can tell us about how to prevent heart disease and stroke,” said Dr. Mariell Jessup, president of the AHA and medical director at the University of Pennsylvania in Philadelphia. “These recommendations will help guide the clinical decisions doctors make every day to protect their patients from two of the nation’s biggest killers.”