Mayo Clinic Challenges Cholesterol Guideline
A Mayo Clinic task force has challenged some recommendations in the updated guideline for cholesterol treatment that was unveiled by the American College of Cardiology (ACC) and American Heart Association (AHA) in 2013. The task force concludes, based on current evidence, that not all patients encouraged to take cholesterol-lowering medications such as statins may benefit from them and that the guideline missed some important conditions that might benefit from medication.
Not only that, but the task force believes an emphasis needs to be placed on an individualized treatment approach with each patient and exercising shared decision-making.
A release from the clinic notes that the task force is made up of Mayo Clinic experts in cardiology, endocrinology, and preventive medicine with no conflicts of interest or links to the drug industry. The recommendations were published August 14th 2014 in Mayo Clinic Proceedings. An editorial will accompany the paper. Mayo Clinic physicians are adopting the task force’s guideline.
The release quotes Francisco Lopez-Jimenez, M.D., task force chairman and director of preventive cardiology at Mayo Clinic in Rochester MN, as saying, “The ACC/AHA cholesterol guideline was last updated in 2001, so it needed to be updated. We agree with many points of the guideline, but there are some key areas where we do not completely agree or we wanted to expand and provide more guidance.”
Mayo’s cholesterol treatment recommendations challenge some core ACC/AHA recommendations, and go further in-depth in some areas. For example:
* The ACC/AHA cholesterol treatment guideline recommends prescribing the strongest statins at high doses to most men older than 65, even those with no history of heart disease, or any major risk factor for heart attacks, and with normal cholesterol levels. Men this age will be classified as high risk only on the basis of age. The Mayo task force found no evidence from clinical trials to recommend treating people only on the basis of age in the absence of risk factors, high cholesterol or inflammation.
* The ACC/AHA cholesterol treatment guideline recommends cholesterol-lowering medication as a primary preventive measure against cardiovascular disease, and encourages health care providers to simultaneously emphasize the importance of healthy lifestyle habits. The Mayo task force encourages lifestyle changes — such as exercise and dietary changes — first, followed by re-evaluating risk in three to six months before prescribing statins, especially in motivated patients and with borderline high risk.