Since the last National Heart Health Month, the medical community underwent a dramatic change in categorizing patients for heart disease prevention and treatment. Citing criticism over conflicts of interest as the main reason for the change, the National Institutes of Health handed over treatment guidelines to the American Cardiovascular Association and the American Heart Association.
“When you change any guidelines, it’s a big undertaking,” says Dr. Merle Myerson, Director of Mount Sinai St. Luke’s and Roosevelt Hospital’s Center for Cardiovascular Disease Prevention. “Guidelines decide who will be treated and who will not. The new guidelines are a drastic change in how to measure risk.”
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The new system switches from monitoring individual blood cholesterol levels, along with other physiological factors, to grouping individuals into one of four complex categories. But Dr. Myerson’s fear is that lumping people into categories might miss some at-risk heart patients, particularly those with familial hypertension, who will be overlooked for testing and treatment.
“When the new guidelines were written, they took into account randomized trials, but not population studies, or epidemiological studies,” she says. “It used to be about knowing your numbers and meeting a target for cholesterol. Now, who should be on meds is split into four groups that benefit from statin therapy. Some people might not simply fall into a group.”
For the public and doctors used to the system of watching cholesterol numbers, the switch can cause confusion.
“Goals and targets are very helpful,” says Dr. Myerson. “In Europe and Canada, the guidelines were similar to our old ones, and have remained the same. I don’t know why it’s necessary to change them here in the U.S.”
Two new drugs
Dr. Myerson notes that the new changes call for a wider use in statins. Here are her thoughts on some other recently released heart meds:
Juxtapid, a low-density lipoprotein (LDL) lowering prescription medication: “This medication is for those with homozygous hypercholesterolemia and complex heterozygous familial hypercholesterolemia. This is very expensive ($250,000 per year) and may have significant side effects, including to the liver.”
Mipomersen, an injectable low-density lipoprotein (LDL) lowering medication: “This has the same indications as Juxtapid, but is less expensive at about $150,000 per year.”