TAMPA — New guidelines for managing heart disease risk will change how some doctors practice medicine and will put more emphasis on patients' behavior, local physicians said Wednesday, a day after the changes were announced by the nation's leading heart organizations.
The new guidance revises how cholesterol-lowering statin drugs should be used, and stresses the importance of diet, exercise and smoking cessation in reducing the risk of heart attack as well as stroke.
"Many of us feel that we've been blindly treating a number and we reflexively give statins to anyone with an LDL (so-called bad cholesterol) over 100," said Dr. Arthur Labovitz, chairman of the department of cardiovascular sciences at USF Health and director of non-invasive cardiology at Tampa General Hospital.
"Now, we must shift our focus to assess the whole patient and give greater emphasis to their other risk factors."
The American Heart Association and the American College of Cardiology urge doctors considering statins to consider not only LDL, but also the patient's other risk factors such as age, gender, race, body mass index, physical activity, smoking status, family and personal history of heart disease, diabetes, and total cholesterol.
"This is the way many of us have been practicing medicine for years. It's the way I was taught in medical school, that we need to treat patients, not numbers," said Dr. Jeremy Bock, a Morton Plant Mease interventional cardiologist. "A cholesterol of 227 doesn't mean anything unless it's attached to a patient. It's the high-risk patients, not just the ones with high cholesterol numbers, that we need to put on statins."
Experts say a small number of patients will come off statins because of the new guidelines. For example, those with LDL between 120 and 150 and no other risk factors might not need a statin. But it's likely that many more people will be advised to go on the medication. The American Heart Association estimates that 33 million Americans who don't have heart disease, but are considered at high risk should be on statins as a preventative measure.
The new guidelines recommend statins for people who:
• Have had a heart attack, stroke or angina
• Have diabetes
• Have genetically high LDL cholesterol of 190 or above
• Have a 10-year heart attack or stroke risk score greater than 7.5 percent.
The risk calculator doctors use to determine a patient's risk considers age, gender, race, total cholesterol, heart attack or stroke history, diabetes, BMI or weight, smoking status, and blood pressure. Until now, a 10-year risk score of 20 percent or higher warranted taking statins. Now it's only 7.5 percent because stroke history has been included.
Labovitz says the message is clear that cholesterol alone isn't an indicator of risk. "If, for example, you've had a heart attack or stroke, it doesn't matter what your LDL is, take the medication. No matter what it is, it isn't low enough," he said.
The new guidelines may also help primary care doctors. "Now they can quickly evaluate patients and make a decision about statins without having to send the patient to a cardiologist or other specialist," said Dr. Augustine Agocha, a cardiologist at St. Joseph's Hospital in Tampa.
They also could help doctors deliver a message many patients don't want to hear, Agocha, Bock and Labovitz agreed.
"We can tell patients that medications alone won't lower your risk. Lifestyle factors like weight, physical activity, smoking, as well as cholesterol, blood pressure and family history all factor into it,'' Agocha said. "This will help us in discussions with our patients."
This article has been revised to reflect the following correction: The surname of interventional cardiologist Jeremy Bock was misspelled in an earlier version.