A provocative review paper published this month has raised questions about the aggressive cholesterol-lowering recommendations made two years ago by a government panel.
The panel, the National Cholesterol Education Program, urged patients at risk for heart disease to reduce sharply their harmful LDL cholesterol and to try to reach specific, very low levels. Though the authors of the new paper, published in the Oct. 3 issue of Annals of Internal Medicine, endorse the use of cholesterol-lowering statins, they say there is not enough solid scientific evidence to support the target numbers for LDL cholesterol set forth by the government panel.
The authors’ argument challenges mainstream medical thinking and the consensus among most cardiologists that the lower the cholesterol is, the better.
Via: New York Times
Via: Annals of Internal Medicine
Key Summary Points
No high-quality evidence could be found that suggests that titrating lipid therapy to recommended low-density lipoprotein (LDL) cholesterol targets is superior to empirically prescribing doses of statins used in clinical trials for all patients at high cardiovascular risk.
Studies addressing benefits of achieving LDL cholesterol goals have had avoidable problems, such as reliance on ecological (aggregate) analyses, ignoring statins' other proposed mechanisms of action, and not accounting for known confounders (especially healthy volunteer effects).
Much more reliable evidence on currently proposed LDL cholesterol goals could be expeditiously produced by conducting cohort analyses of past statin trials that control for statin dose and pill adherence.
Dichotomous comparisons (such as comparing those who reach goal vs. those who do not) can mistakenly suggest that not achieving the treatment goal results in moderate risk when in fact almost all of the risk is caused by large deviations from the ideal goal.
Proposals for treatment goals should also consider the risks, patient burden, and societal costs of the treatments that may be needed to reach those goals.
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