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Are the New Cholesterol Guidelines Really an Improvement?

new cholesterol guidelines

Photo credit: American Heart Association

At 17, I sat in my pediatrician’s office (yes, my pediatrician) and received the news that I, a healthy, active, vegetarian teenager, had high cholesterol. I’d just returned from a monthlong stint in the Domincan Republic volunteering at an orphanage. We ate what they ate: lots of rice, beans, plaintains, and water. To say I could blame my cholesterol levels on my diet was unreasonable, yet I still made a conscious effort to watch what I ate. I avoided shrimp, eggs, and cheese, before I learned that dietary cholesterol actually had little to do with blood cholesterol levels. Luckily I was able to get around the need for medication by finding a loophole: I raised my good cholesterol levels enough to counteract for my bad cholesterol levels.

But what if I’d needed medication? I can certainly tell you from experiences with family members that a statin would not have been my first line of pharmaceutical defense. The side effects of muscle pain and confusion were too common, at least anecdotally, for me to be interested in signing myself up for that. But that’s exactly what the new cholesterol guidelines are telling doctors to do: push statins.

I first read the guidelines through the eyes of a dietitian who doesn’t care so much for what I learned in school 10 years ago, but instead on experience and ever-evolving research. Research that says the exact cholesterol number isn’t as important as your risk for heart disease, stroke, and chronic illness. I was pleased to read that precise numbers were no longer the focus. The new guidelines acknowledge that achieving a specific lab profile using cholesterol medication has little to do with decreasing one’s risk of heart disease. I was aghast, however, to read that the main line of treatment for those with cholesterol levels higher than 190 mg/dl (which is considered high), as well as those with heart disease or diabetes, was to prescribe a statin. Lowering LDL cholesterol is no longer a goal; taking a statin is.

While we should most definitely be looking at decreasing disease and disease risk instead of individual lab numbers, these guidelines are estimated to double the number of people who will “need” statins. That means double the number of people that are at risk for side effects. Double the number of people that will have to pay up to $200 a month for yet another medication. Double the number of people that aren’t focusing on improving their health through diet and exercise. Sure, the guidelines mention diet and exercise, but they absolutely push drug intervention. It’s good that we have access to such medications and lines of defense, but shouldn’t they be a last resort? For those people who can’t decrease their risk of heart disease through other measures? The guidelines dictate that those with a 7.5% or higher risk of having a stroke or heart attack in the next 10 years be given medication. But isn’t there a lot more we could accomplish through 10 years of a healthy diet and exercise?

I do everything I can to keep my family off of medication, saving that route for when it’s absolutely necessary. Otherwise our cabinets would be full of red plastic pill bottles instead of fruits, veggies, and other healthy foods, and our money would be going to the pharmacy instead of our gym memberships. Instead, we focus on staying active and putting good food on our plates. Didn’t Benjamin Franklin say, “An ounce of prevention is worth a pound of cure”? That’s the approach we take in my house.

Interestingly enough, the “risk calculator” for determining whether you need a statin or not under these new guidelines has already been taken offline due to need for improvement.

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