New cholesterol guidelines represent the biggest change in more than 25 years

New cholesterol guidelines for identifying adults at risk for heart disease represent the biggest change in such expert advice in more than 25 years, according to Loyola University Health System preventive cardiology experts.

"This is very big news," said Binh An P. Phan, MD, director of Loyola's Preventive Cardiology and Lipid Program. "These new guidelines could dramatically affect how cholesterol is treated."

Under the guidelines, patients generally would be put on a cholesterol-reducing statin medication based on a formula that estimates their risk for cardiovascular disease. This is a major change from previous guidelines that placed more emphasis on patients' cholesterol numbers.

The clinical practice guidelines were issued by the American College of Cardiology and American Heart Association. They are intended to better identify adults who may be at risk for cardiovascular disease and who thus may benefit from lifestyle changes or statin cholesterol medications.

The guidelines could simplify the process of identifying patients who could benefit from statin therapy, said Loyola cardiologist Ivan V. Pacold, MD, an expert in preventive cardiology. Dr. Pacold is medical director of Cardiology at Loyola's Gottlieb Memorial Hospital.

"The guidelines emphasize that starting and keeping patients on statin treatment is more important than looking at the actual cholesterol-lowering effect of the treatment," Dr. Pacold said.

However, the guidelines are controversial. They have not been endorsed by the National Lipid Association, a multidisciplinary medical society that focuses on controlling cholesterol.

The guidelines are intended to meet the needs of patients in most circumstances. They are not meant to be a replacement for clinical judgment.

"For the many questions regarding complex lipid (cholesterol) disorders that are beyond the scope of our systemic evidence review, or which little or no RCT [randomized clinical trial] data are available, it is anticipated that clinicians with lipid expertise can contribute to their management," the guidelines say.

Cardiologists in Loyola's Preventive Cardiology and Lipid Program have special expertise in preventive cardiology and are board-certified in the field of lipidology and advanced cholesterol management by the American Board of Clinical Lipidology.