Will New Statins/Cholesterol Guidelines Lead To Over- Or Under-Treatment? We Shall See.

Merck’s (legacy Schering-Plough’s) Zetia® is called out here, by name. And to be sure — this is the biggest change in treatment guidelines in three decades in America. So, big news.

Cool — the highly-regarded Dr. Harlan Krumholz is quoted — and quite prudently so. Even so, I like Dr. Ridker’s concluding pull-quote the best, I think.

Here it is, from the New York Times, tonight — do go read it all:

. . . .It is not clear whether more or fewer people will end up taking the drugs under the new guidelines, experts said. Many women and African-Americans, who have a higher-than-average stroke risk, might find themselves candidates for treatment, but others taking statins only to lower LDL cholesterol to target levels might no longer need them.

“Now one in four Americans over 40 will be saying, ‘Should I be taking this any more?‘” said Dr. Harlan M. Krumholz, a cardiologist and professor of medicine at Yale who was not on the guidelines committee.

The previous guidelines put such a strong emphasis on lowering cholesterol levels by specific amounts that patients who did not hit their target levels just by taking statins often were prescribed additional drugs like Zetia. But the new guidelines say doctors should no longer prescribe those extra medicines because they have never been shown to prevent heart attacks or strokes. . . .

Dr. Paul M. Ridker, the director of the center for cardiovascular disease prevention at Brigham and Women’s Hospital, in Boston, said he worried the new guidelines could easily lead to overtreatment. An older man with a low LDL level who smokes and has moderately elevated blood pressure would qualify for a statin under the new guidelines. But what he really needs is to stop smoking and get his blood pressure under control. . . .

True ‘dat. This is clearly Act Two, of a Three Act play. Do stay tuned.

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