(HealthDay News) -- Nearly three-quarters of patients hospitalized for heart attacks had cholesterol levels indicating they were not at high risk for cardiovascular trouble, a new, nationwide study shows.The finding points to the possibility that current guidelines on cholesterol levels should be changed, said study author Dr. Gregg C. Fonarow, a professor of cardiovascular medicine and science at the University of California, Los Angeles. His report appears in the current issue of the American Heart Journal.
"The LDL cholesterol range at which people have heart attacks shouldn't be regarded as normal," Fonarow said.
LDL cholesterol, the "bad" kind, collects to form plaques that can eventually block arteries. Guidelines compiled by the U.S. National Heart, Lung and Blood Institute set an LDL cholesterol blood level target of 130 milligrams per deciliter for people with no cardiovascular disease or diabetes and 70 for those at high risk because of factors such as obesity, smoking and high blood pressure.
But the study of nearly 137,000 Americans hospitalized for heart attacks between 2000 and 2006 found that about 72 percent had LDL levels below 130 on admission, while 17.6 percent had LDL levels below 70.
"People with LDL cholesterol levels in the 100 to 130 range may feel they are at low risk," Fonarow said. "In this study, there was nothing normal about having an LDL reading of 100."
The study also looked at levels of HDL cholesterol, the "good" kind that helps prevent artery blockage. Current guidelines recommend an HDL level of 60 or higher, but the study found levels below 40 in 54.6 percent of the heart attack patients.
Only 1.4 percent of patients met the recommendation for both an LDL level of 70 or lower and an HDL reading of 60 or higher, Fonarow noted.
The current National Cholesterol Education Program guidelines were first set in 2001, and were updated in 2004. The NHLBI is expected to review those guidelines in the near future, Fonarow said.
"My opinion, based on the totality of the evidence that has come out, is that it is likely that there will be important revisions to the guidelines, but that should be determined by the individual advisory groups that will be writing them," he said.
In its update of the guidelines, the NHLBI called for more use of measures such as physical activity and weight loss to reduce the risk of heart attack and other cardiovascular problems.
Cholesterol is only one part of the heart risk picture, Fonarow said. Risk climbs higher with age, especially for men and for those with close relatives who have had cardiovascular conditions.
"The good news is that as much as 80 percent of the risk factors are under individual control and are modifiable," Fonarow said. "You can't control your family history, age or sex, but you can keep your blood pressure low, exercise and modify your lifestyle in other ways to reduce risk."
While calling the study "excellent," Dr. Manesh Patel, an assistant professor of medicine at Duke University, added, "The problem is that this is a snapshot, but we're not sure we know all the risk factors and how they interplay."
The researchers did not measure blood levels of other molecules involved in cardiovascular disease, such as the inflammation biomarker C-reactive protein and lipoprotein(a), he said.
But it's quite possible that the cholesterol guidelines will be changed, Patel said. "Ongoing studies have led to getting the LDL level to 100 and then to 70," he said. "As more randomized trials come out, there may be further changes."
More information
For the full cholesterol story, go to the U.S. National Library of Medicine.
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What Is Believed To Be Qualities Of All Statin Medications:
Statins are a class of medications specifically prescribed to lower LDL- one of five lipid parameters of a person’s lipid profile, which is alto the name of the blood test to measure these parameters. They are known as statins, as all of these types of medications end with the letters, statin.
There are about 6 available statins to choose for lipid management as needed- with three that are combination drugs that have a statin included in these drugs.
There are other classes of medications for lipid management, such as bile acid sequestrants and nicotinic acid, which is known as niacin. Yet the side effect profile is more unfavorable of these classes of medications compared with the statin class of drugs.
One’s cholesterol level is primarily due to how they produce cholesterol in their liver, which is overall genetically determined. This level is also determined by one’s lifestyle and diet as well. If a person has too much cholesterol in their blood, it can lead to hardening and narrowing of their arteries as well as the formation of coronary plaques in the coronary arteries.
If these plaques break off of the arterial wall, this leads to a myocardial infarction, or heart attack. Statins are believed to stabilize coronary plaques so this does not occur.
To measure one’s cholesterol, a blood test called a lipid profile is obtained from a person after they have fasted for at least 12 hours. The test should also be performed only if the person is free of any acute illness, as this may affect true lipid measures.
If the results prove to be abnormal, lipid altering medicinal therapy may be initiated- according to the discretion of the person’s health care provider. This therapy usually involves a statin medication.
Adverse events associated with the statin class of pharmaceuticals are thought to occur more often than they are reported- with high doses of statins prescribed to patients in particular at times that may not be necessary to control their dyslipidemia based on their lipid profile. Side effects may include muscle pain, or possible damage to the patient’s liver.
However, since this class of statin drugs has existed for use for over 20 years, statins are considered to be overall safe and effective for enhancing the clearance of LDL noted to be elevated in the lipid profiles of patients.
Also, they have proven to reduce cardiovascular mortality with one who is treated with a statin that has dyslipidemia. In addition to lowering LDL by up to about 60 percent- depending on the choice of the statin prescribed for the patient, and how high the LDL cholesterol is in a patient.
This class of drugs also has the ability to raise their HDL lipid parameter as well as lower to their benefit their triglyceride parameter of their lipid profile. Both of these additional effects in addition to lowering the LDL parameter from taking a statin drug is ultimately beneficial for the patient on a statin drug for lipid management.
Statin therapy is also recommended for those patients who have a greater than twenty percent risk of developing cardiovascular disease, or those patients that have clinical evidence of this disease.
Additionally, there appears to be no comparable reduction in cardiovascular morbidity or mortality, as well as a difference in the increase of one’s lifespan, if one is on any particular statin medication for their lipid management over another, others have concluded. So caution should perhaps be considered if one chooses to prescribe a statin for a patient if they are absent of, or have only mild dyslipidemia to a significant degree.
Furthermore, research should be done by the health care provider if they are under the belief that one statin medication provides a greater cardiovascular benefit over another. In other words, the health care provider should be assured that any choice of statin therapy for their patients is considered reasonable and necessary if the LDL in their patients need to be reduced, and the statin selection should be determined by the results that have been shown with a particular statin.
There exist abstract etiologies for health care providers at times to choose to prescribe statin drugs on occasion for reasons not indicated with the medicinal treatment of these statin drugs. Examples include the speculated benefits associated with statins- such as reducing CRP levels, or for Alzheimer’s treatment, or other reasons not directly related to cholesterol management.
Statin therapy for such patients may not be considered appropriate, reasonable, or necessary prophylaxis at this point for any patient who does not have the indications for which statins are approved for to treat patients with dyslipidemia. All other benefits that appear to have favorable effects in such areas not involved with a patient's cholesterol are suggested at this point due to minimal research in these other variables aside from lipid management.
Other reasons for placing a patient on a statin drug at this time require further research for these disease states and dysfunctions that may exist with a patient aside from dyslipidemia.
Statins as a class of drugs seem to in fact decrease the risk of cardiovascular events significantly, it has been proven. Statins also decrease thrombus formation as well as modulate inflammatory responses (CRP) as additional benefits of the medication.
For those patients with dyslipidemia who are placed on a statin, the effects of that statin on reducing a patient’s LDL level can be measured after about five weeks of therapy on a particular statin drug.
Liver Function blood tests are recommended for those patients on continued statin therapy, and most are chronically taking statins for the rest of their lives to manage their lipid profile in regards to maintaining the suitable LDL level for a particular patient presently. Patients should be made aware of potential additional side effects as well, such as myopathy and muscular dysfunctions that occur on occasion when one is on statin therapy.
Yet some have said that about half of all strokes and heart attacks that do occur are not because of increased cholesterol levels of these patients. So it appears clear that high cholesterol may not be an absolute for cardiovascular events for them to occur.
Others believe that it is oxidized cholesterol that causes vulnerable plaques to form on coronary arterial walls, which is the catalyst for a heart attack, and that there is no medicinal treatment for the formation or stabilization of these plaques to prevent heart attacks or strokes.
Some who support statin medicinal therapy for their clinically appropriate patients claim that these drugs, do, in fact, stabilize these plaques as an added benefit, and therefore are beneficial.
As stated previously, in regards to other uses of statins besides just primarily LDL reduction, there is some evidence to suggest that statins have other benefits besides lowering LDL, but not enough evidence yet.
These other disease states include aside from what has been stated already, such as those patients with neurological disease, as well as statins being beneficial for certain cancer patients. Some have suggested that statins interfere with cancer treatment with bladder cancer patients as well. Yet again, these other roles for statin therapy have only been minimally explored and researched, comparatively speaking.
Because of the limited evidence regarding additional benefits of statin medications, the drug should again be prescribed for those with dyslipidemia only at this time involving elevated LDL levels as detected in the patient’s bloodstream.
Yet overall, the existing cholesterol lowering recommendations or guidelines should possibly be re-evaluated. The cholesterol guidelines that presently exist may be over-exaggerated possibly due to tacit suggestions from the makers of statins to those who create these current lipid lowering guidelines.
This is notable if one chooses to compare these cholesterol guidelines with the other guidelines that have existed in the past. The cholesterol guidelines that exist now are considered by many health care providers and experts to be rather unreasonable and unnecessary, as well as possibly have the potential to be detrimental to a patient’s health.
Yet statins are beneficial medications for those many people that exist with elevated LDL levels that can cause cardiovascular events to occur because of this abnormality. What that ideal LDL level is may have yet to be empirically determined.
Finally, a focus on children and their lifestyles should be amplified so their arteries do not become those of one who is middle-aged, and this may prevent them from being candidates for statin therapy now and in the future, regarding the high cholesterol issue. Treating children with a statin drug for dyslipidemia is controversial presently. Dietary management should be the first consideration in regards to correcting lipid dysfunctions that may exist in patients.
www.americanheart.org
Dan Abshear
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