Should all patients at any risk of developing cardiovascular events receive high intensity statin therapy regardless of current blood cholesterol levels?

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A new report by the American College of Cardiology (ACC) and the American Heart Association (AHA) concludes that statin therapy is crucial in the prevention of cardiovascular events, and recommends high-intensity therapy for all at risk individuals regardless of current blood cholesterol levels.

Background

Diabetes is a major risk factor for the development of cardiovascular (heart and blood vessel) diseases. Since high cholesterol levels also significantly increase this risk, proper management over blood cholesterol is crucial in preventing hypertension (high blood pressure), heart attacks and strokes. The first guidelines on the management of cholesterol levels were written in 2008 by the ACC/AHA task force on clinical practice. This expert panel analyzed all relevant research published in recent years to provide new clinical practice guidelines for the management of cardiovascular risk and blood cholesterol levels.

Recommendations

After an extensive review of recent evidence, the expert panel concluded that all patients at any risk of developing cardiovascular events should receive high intensity statin therapy(cholesterol reducing drugs) regardless of current blood cholesterol levels. The updated guidelines no longer recommend treating to a specific target cholesterol level, as evidence has not shown this strategy to be effective in preventing cardiovascular events. Instead, the new guidelines recommend that:

  1. All patients who have already presented with any symptom of cardiovascular disease (for example those who have already experienced a heart attack, chest pain or a stroke) are advised to begin high-intensity statin therapy. For patients older than 75 years of age, or those who cannot tolerate high-intensity treatment, a moderate-intensity regimen is recommended.
  2. All adults with high cholesterol levels be treated with high-intensity statin therapy, regardless of whether any symptoms of cardiovascular disease exists.
  3. All adults 40 to 75 years of age with diabetes should be treated with high-intensity statin therapy, even if blood cholesterol levels are within normal range and no evidence of cardiovascular disease exists.
  4. All adults 40 to 75 years of age, even if their blood cholesterol levels are within normal range, should be treated with high-intensity statin therapy if their estimated 10-year risk of developing cardiovascular disease exceeds 7.5% (according to various factors such as family history, additional medical conditions and lifestyle factors).