Is Aggressive Cholesterol Control Neccessary?
A report earlier this month in the Medical News Today expressed concern over the recommendations from “The American National Cholesterol Education Program” that people at “high risk” should be treated more aggressively. By more aggressively, they mean a reduction in LDL (so called bad cholesterol) from the current level of 2.56 mmol/L down to 1.81 mmol/L a reduction of 30%. The study was reported in the British Medical Journal vol. 332, p. 1330.
Here’s the commentary from Medical News Today.
Concern Over ‘aggressive’ Cholesterol Recommendations
It’s interesting they note that to achieve these levels most adult in the western world would require higher doses of statins higher than currently used. Here’s the paragraph:
To achieve this new goal, most of the Western world’s adult population would be on statins, and doses would have to be more than eight times higher than currently used, say the authors. This would increase both the number and seriousness of side effects.
But clinical trials suggest that higher doses of statins do not lower overall mortality and side effects are generally under-reported.
The authors conclude that any reduction in non-fatal events may be outweighed by more numerous and more severe adverse effects.
As I have stated before, I believe that for any drug and a given patient you need to weigh the risk vs. the reward. No drug is totally safe and if you recommend increasing the dose and the number of people using them you are going to see an increase in the number of side effects. Since the study states that overall mortality is not reduced and that side effects are generally under reported is this a good recommendation? I firmly believe that well thought out guidelines are useful but this seems to me to be overboard. I also think that these sorts of decisions need to be made on a personal level of a patient and their doctor based on their medical situation. While drugs are certainly helpful, the reward should be evaluated against the potential risks.
My overall opinion, while cholesterol should be kept down, I don’t think this specific recommendation is warranted.
Technorati Tags: cholesterol
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