To clarify the basis of the new prevention guidelines, The Lancet recently published an editorial comment by Donald M. Lloyd-Jones, MD ScM, David Goff, MD PhD, and Neil J. Stone, MD, FACC, who responded to an editorial by Paul Ridker, MD, MPH, FACC and Nancy Cook, MD.

They note that “importantly, only about 31 percent of Americans aged 40—75 years without existing cardiovascular disease might be eligible for statin therapy under the new guidelines. This is remarkably similar to what would have occurred under the previous guidelines if the threshold for treatment were lowered modestly from 20 percent 10-year risk of a heart attack to 10 percent risk, well short of the threshold of proven benefit in recent trials. Further, many of these patients are likely already on statin therapy, and many would be recommended for treatment by either risk assessment approach.”

The sobering statistics are that currently, “more than 70 million Americans are regarded as candidates for blood pressure lowering drugs to reduce risk for heart disease and stroke.”

Lloyd-Jones, Goff and Stone write that “these numbers are cause for a call to action to first focus on the prevention of cardiovascular risk factors such as high cholesterol and high blood pressure. Until we get serious about personal lifestyle modification and national policies to promote environmental and behavioural change, we will need blood pressure lowering medications and statins to contain the epidemic of cardiovascular disease.”

Interestingly, according to a recent study released by Symphony Health Solutions, although there has been debate over the new 10-year cardiovascular risk algorithm, “most practicing physicians agree with the new guidelines and are already treating their patients in-line with them.”

In addition, the study predicts that “only a modest 5 percent increase in the total number of U.S. patients prescribed statins — a stark contrast to the ‘doubling of statin use’ that has been discussed in the press.”

It is worth repeating that the ACC and AHA stand behind the new guideline. We also released a set of clinical tools to accompany the guideline including the risk assessment calculator, weekly prevention case challenges, and information about each guideline topic for your patients, available at CardioSource.org/Prevention along with several expert commentaries and additional resources.

Also, in case you missed it, here is additional commentary provided by Harlan Krumholz, MD, SM, FACC in a recent British Medical Journal editorial: “Target cardiovascular risk rather than cholesterol concentration.”

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