Most surprising to some is the new guideline recommendation that treatment not be focused on the LDL level, which has been targeted at 70 mg/dL or lower, or on non–HDL cholesterol targets for primary or secondary prevention. “The backing away from treating to a target LDL is interesting and surprising,” Dr. Solomon says. “It is based on the fact that most statin randomized controlled trials do not use a treat-to-target strategy. Having said that, there are very strong data that more aggressive lipid lowering is associated with a continued reduction in risk,” he says.
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“We know that patients with several systemic rheumatic diseases are at an increased risk for cardiovascular disease, and prior research suggests that statin prescribing in rheumatology patients is suboptimal. It is very easy for patients with a dominant condition like rheumatoid arthritis to have routine health maintenance overlooked,” Dr. Solomon says. “Rheumatologists can feel comfortable using the earlier version of the lipid guidelines to select patients for recommending statins.”
Clear evidence-based guidance on managing lipids in patients with rheumatoid arthritis is needed, according to Dr. Solomon. He says that data from a large statin trial for rheumatoid arthritis conducted in the U.K. are expected soon and “may help clarify treatment recommendations” for these patients.
Kathy Holliman is a medical journalist based in New Jersey.
- Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013 Nov 7. [Epub ahead of print]
- American Heart Association. 2013 Prevention Guidelines Tools: CV Risk Calculator. http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp. Accessed Dec. 11, 2013.
- Ioannidis JPA. More than a billion people taking statins?: Potential implications of the new cardiovascular guidelines. JAMA. 2013 Dec 2. [Epub ahead of print]
- Ridker PM, Cook NR. Statins: New American guidelines for prevention of cardiovascular disease. Lancet. 2013;382:1762-1765.