October 18th, 2012
Should Hypercholesterolemia Treatments Start Much Sooner in Life?
Keeping LDL cholesterol low throughout life is more effective at preventing atherosclerotic disease than starting statins in middle age, a series of analyses in the Journal of the American College of Cardiology shows.
Researchers first established the effects of several genetic variations on naturally lowering LDL. People with one or more of these variants had their risk for coronary heart disease reduced by over half for each 40 mg/dL reduction in long-term exposure to LDL, relative to those without the variants. Next, researchers found that trials of statin therapy, participation in which usually begins later in life, had a much lower risk reduction — about 25%.
Editorialists say that the analyses, in their view, justify “acting without waiting” for a randomized trial. They recommend focusing on lifetime risk — as opposed to the 10-year risk window of the Framingham risk score — and starting lifestyle changes or drug treatment much sooner.
Reprinted with permission from Physician’s First Watch