NORTHWESTERN DOC DEFENDS NEW CHOLESTEROL GUIDELINES
A Northwestern Memorial Hospital cardiologist has found himself in the middle of a controversy over new guidelines aimed at preventing heart attacks and strokes.
The new guidelines discard the old cholesterol level targets used by doctors for decades and rely on a formula that uses such factors as age, race, gender and medical history to determine the risk of heart disease and stroke.
But within a week of the guidelines’ release in mid-November, two Harvard medical professors came out with a study claiming the guidelines’ formulas greatly overestimated a person’s risk of heart attack or stroke and could lead to overprescription of drugs.
However, Dr. Neil J. Stone, the Northwestern cardiologist who chaired the committee that wrote the guidelines, said he stands by his panel’s work.
“A group from Harvard questioned our risk calculator, but we have disputed what they have said, and that’s being resolved right now,” Stone told the Sun-Times. “They presented some data that, very frankly, we feel didn’t in any way negate what we said the risk calculator was for.”
And despite the claimed overestimation of risk, one of the Harvard authors, Dr. Paul Ridker, a Harvard Medical School professor, still “strongly supports the key messages of the new guidelines and believes that questions raised about the risk calculator should be relatively easy to address,” according to a statement released by his hospital. Stone said the flurry of news stories in the wake of the dispute took the focus off the guidelines, which he said remain sound.
“A lot of doctors are commenting on headlines instead of on the guidelines,” Stone said.
Stone emphasized that the guidelines are the first that customize risk for blacks versus whites and women versus men. And while previous risk calculators only looked at heart disease, this calculator also accounts for strokes.
Stone said recommended target cholesterol levels were eliminated because evidence didn’t support the levels. “We couldn’t find information to prove that 70 was better than 80 or 80 was better than 90.”
For people whom the new calculator identifies as being at risk, the guidelines recommend treatment with cholesterol-lowering statin drugs such as Lipitor, Zocor or their generic forms.
“We found out that there was a class of drugs called statins that were inexpensive, safe when given as we indicated, and that in four large groups remarkably lowered rates of heart attacks and stroke,” Stone said.
The four groups are people:
With heart disease or who have had strokes
With high cholesterol levels because of genetic factors
Age 40 to 75 with Type 2 diabetes
Age 40 to 75 with an estimated 10-year risk of heart disease of 7.5 percent or higher.
The fourth category was the one called into question by the Harvard researchers.
Stone also disputed estimates that the number of patients taking statins would double or triple under the new guidelines.
“That’s not our calculation,” he said. “We think that about the same number of people are still going to take statins, except we’re going to more appropriately give them to those who need them.”
The committee also came under criticism for its members’ links to the drug industry, but the statin drugs it recommended are available in cheap generic versions.
Stone said the committee solved any conflict-of-interest issues by hiring an outside group to grade research articles it used as a basis for the guidelines. “The scientific data was independently determined. Our panel had no involvement on what papers they gave us. It’s a pretty airtight process, and anyone who claims that there was bias would be hard-put to find out how that would have happened,” Stone said.
“In fact the votes were almost unanimous because all we could say is what the data showed.”