The Pharmaceutical Journal
Vol 273 No 7308 p78
17 July 2004

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More intensive cholesterol lowering in US

More intensive cholesterol treatment is an option for those at high risk of cardiovascular disease, according to updated US guidelines.

The new recommendations come from the US National Cholesterol Education Program clinical practice guidelines on cholesterol management. To refine 2001 guidelines, a panel examined five major clinical trials involving cholesterol-lowering medication.

Conversion table

US figure UK figure 70mg/dL 1.81mmol/L 100mg/dL 2.59mmol/L 130mg/dL 3.36mmol/L

For those at high and very high risk of heart attack or death, the overall goal remains an LDL level of less than 100mg/dL. But for those at very high risk (more than a 20 per cent risk in 10 years), the guidelines now offer the option of treating to less than 70mg/dL (see conversion table). This group includes those with current cardiovascular disease plus diabetes, persistent cigarette smokers, patients with poorly controlled hypertension and those immediately after a heart attack.

Previous guidelines recommended medication for those at high risk with LDL levels of 130mg/dL or higher, with only optional treatment for those with an LDL of 100–129mg/dL. A new option is now to treat patients with LDL 100–129mg/dL.

For those at moderately high risk the new guidelines reinforce the need for treatment if LDL cholesterol levels are 130mg/dL or higher. But the update gives an option to set a lower LDL goal of under 100mg/dL and to use drug treatment between 100–129mg/dL to reach this goal.

The updated recommendations say that drug therapy in those at high or moderately high risk should be aimed at achieving a 30–40 per cent reduction in LDL cholesterol.

The new guidelines also bolster the concept of treating older patients.

“The recent trials add to the evidence that when it comes to LDL cholesterol, lower is better for persons with high risk for heart attack,” said the acting director of the US National Heart Lung and Blood Institute, Barbara Alving.