Updated cardiovascular health guidelines were released today by the American Heart Association (AHA) and the American College of Cardiology (ACC). The guidelines are designed to provide primary care physicians with evidence-based expert guidance on cholesterol, obesity, risk assessment, and healthy lifestyle.
The new guidelines reinforce many of the same messages from previous guidelines, but also represent a sharp change in philosophy. That change is most evident in the new lipid guidelines, in which the focus has shifted away from setting numerical targets for cholesterol levels in favor of treatment decisions based on individual risk status.
“This guideline represents a departure from previous guidelines because it doesn’t focus on specific target levels of low-density lipoprotein cholesterol, commonly known as LDL, or ‘bad cholesterol,’ although the definition of optimal LDL cholesterol has not changed,” said Neil J. Stone, chair of the lipid expert panel that wrote the new guideline. “Instead, it focuses on defining groups for whom LDL lowering is proven to be most beneficial.”
The long-awaited and often controversial guidelines are the successors to the extremely influential NHLBI guidelines, including the Adult Treatment Panel (ATP) series of guidelines that brought cholesterol to the consciousness of millions of people. Earlier this year the NHLBI announced that it would no longer issue guidelines but would, instead, provide support for guidelines produced by other organizations. Following the NHLBI announcement, the AHA and the ACC said that they would take over publication of the guidelines.
Statins Indicated for Four Broad Groups
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Original illustration by Max Husten
Is there a reason that this risk calculator does not include physical activity? The guidelines speak to the importance of being active to reduce risk, but then the calculator seems to assume that a couch potato and a daily bicycle commuter have the same risk (all other parameters being equal).
The Global Vascular Risk Score Calculator produced by Columbia University and the University of Miami does include physical activity… and that measure can easily tip someone from one side to the other of the 7.5% 10-year risk guideline for primary prevention using statins.