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New guidelines urge early use of cholesterol-busting drug

You can stop agonizing over the details of your blood lipid profile test. Doctors may no longer use “high LDL value” and “low HDL value” as the only criteria to start patients on cholesterol busting drugs. 

If the new guidelines released by the American Heart Association (AHA) and the American College of Cardiology are followed as diligently by the local medical fraternity as in the past, doctors will not concentrate on these numbers, but study the patient’s risk factors before writing out a prescription.

“These guidelines will significantly change the way we treat heart diseases,” said senior heart surgeon Dr Ramakanta Panda. However, a few doctors felt that these guidelines would only help increase the sale of statins—the cholesterol-control drugs that have in the last decade revolutionised cardiac care.

So, why are the new guidelines being hailed as a “tectonic shift” that will “fundamentally reshape” treatment of heart patients? The guidelines make doctors work easy by identifying four groups that need statins immediately: patients with existing heart disease, those with an LDL or “bad” cholesterol level of 190mg/dL or higher, those with Type 2 diabetes and are 40-75 years of age, and those with an estimated 10-year risk of heart disease of 7.5% or higher and are 40-75 years of age.

Cardiologist Ganesh Kumar from Powai’s L H Hiranandani Hospital said, “Earlier,if a patient had diabetes, we had to bring down his/her levels down to 70. There was a lot of calculation to be done.”

Dr Anoop Misra, chairman of Fortis Centre for Diabetes in Delhi, said the rules have “simplified” previous protocols. 

Endocrinologist Dr Shashank Joshi from Lilavati Hospital said the message is clearly to hit hard and hit early with statins. “There is enough evidence to show that statins work while non-statin drugs are not useful.”

Dr N O Bansal, who heads the cardiology department of JJ Hospital, said that the new guidelines follow the JUPITER trail that began over four years ago. “The trial found that all patients had reduced levels of LDL cholesterol by using a new type of statin.” 

But preventive cardiologist Dr Aashish Contractor felt the rules would act as a windfall for pharma firms. “The risk calculator put out with these guidelines show that most patients over the age of 60 would have a risk factor of 7.5% for heart attack or stroke. In effect, all patients need statins,” he said. 

Dr Bansal conceded that the sale of statins would increase. “But there hasn’t been any drug that has been as effective in controlling cardiovascular diseases. Its worse side-effect is muscular pain.” 

Some experts also felt the need for desi guidelines. “The Indian cholesterol is different from other ethnic groups. We eat a diet rich in carbohydrates unlike the West, where red meat and protein are preferred. We are more sedentary than others. It is time we developed our own guidelines,” Dr Shashank Joshi said.