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New cholesterol guidelines signal no change for metabolic syndrome screening

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The updated cholesterol guidelines for the treatment of high blood cholesterol levels released by the American College of CardiologyAmerican Heart Association (ACC-AHA) Task Force on Practice Guidelines, on November 12, 2013, may initially have little or no impact on Metabolic Syndrome (MetS) Screening programs.

One reason is because the new guidelines focus on low-density lipoprotein (LDL) cholesterol … also known as “bad cholesterol”, whereas MetS screening focuses on high density lipoprotein (HDL) cholesterol … also known as “good cholesterol” … and triglycerides. In addition the new guideline also emphasizes the importance of adopting a heart-healthy lifestyle to prevent and control high blood cholesterol. MetS screening identifies risk factors that also result in adopting a heart-healthy lifestyle.

MetS is diagnosed when three or more metabolic risk factors within the body are found to be outside normal ranges when tested. Abnormal levels have been associated with an increase risk for heart disease and other related health problems, such as diabetes and stroke.

The five metabolic risk factors include; (source: National Heart, Lung and Blood Institute)

  • A waist size of more than 35 inches for women or more than 40 inches for men (in some cases as low as 37 inches).
  • A fasting triglyceride level of greater than 150 mg/dL, or on medication for the treatment of high triglycerides).
  • A High Density Lipoprotein (HDL) level, also referred to as "Good Cholesterol" of under 50mg/dL for women and under 40mg/dL for men, or on medication to treat low HDL. The higher the HDL the more beneficial.
  • High blood pressure, (systolic; 130mm/HG or higher, diastolic 85mm/HG or higher), or on medicine to treat high blood pressure.
  • High fasting blood sugar of 110mg/DL, or on medication to treat high blood sugar. Some MetS testing criteria is as low as 100mg/DL.

The New ACC/AHA Cholesterol Guidelines

The prior version of these guideline promoted specific lipid-level goals for patients that were based on the level of risk and focused on reducing elevated levels of LDL’s to within a desirable range utilizing various medication therapies. The newest version is now more focused on underlying medical conditions, rather than primarily just looking at routine assessments of LDL cholesterol, to guide medication treatment decisions.

With target levels of LDLs no longer the only emphasis, if health care providers adapt the new guidelines, this could virtually eliminates routine assessments of LDL cholesterol levels in patients receiving statin therapy, and routine assessment of LDL’s by themselves will most likely not be covered under insurance for preventive care. According to one source in the attached video, this could result in millions of individuals now being placed on high intensity statin therapy, that previously would not have been considered for statin therapy.

High-intensity statin therapy (designed to reduce LDL cholesterol levels by ≥50%) is now generally recommended for patients that also fall within the group of underlying medical conditions. The group of patients that fall within this recommendations include;

1. "clinically evident atherosclerotic cardiovascular disease,"

2. "primary LDL cholesterol levels of at least 190 mg per deciliter,

3. "type 1 or type 2 diabetes and an LDL cholesterol level of 70 mg per deciliter or higher, or

4. "a 10-year risk of atherosclerotic cardiovascular disease of at least 7.5%, according to the new, publicly available, pooled cohort equations, and an LDL cholesterol level of at least 70 mg per deciliter."

Persons receiving statin therapy, especially high-intensity statin therapy should also be "monitored for muscle and hepatic injury and for new-onset diabetes."

However there are individuals who cannot tolerate high-intensity statin therapy. For these individuals and patients with diabetes and a 10-year risk of atherosclerotic cardiovascular disease of less than 7.5%; a "more moderate-intensity statin therapy (aiming for a reduction of 30 to <50% in LDL cholesterol levels) is recommended."

The new guidelines “also identify patients for whom available data does not support statin therapy and for whom no recommendation is made" including;

1. " age of more than 75 years, unless clinical atherosclerotic cardiovascular disease is present;"

2. "a need for hemodialysis;"

3. “New York Heart Association class II, III, or IV heart failure.”

Of interest is the additional finding of the panel that there was "no evidence to support the use of non-statin cholesterol-lowering drugs"

The previous guidelines were widely accepted; however, the new guidelines have already been challenged, with some arguing that specific components of the recommendations are not evidence-based. Nevertheless, the new recommendations may still have a major effect on the how various blood lipids are managed by care givers.

The revised guidelines also include the use of a new risk calculator for targeting larger numbers of patients for statin treatment. However based on findings of Ridker and Cook the risk calculator is being challenged for not having "been prospectively tested for its accuracy in predicting cardiovascular risk" and it "appears to overestimate observed risks". The guideline developers disagree.

This information is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical/nutritional/fitness advice. Information presented is subject to change as additional discoveries are made or additional research is published.

Additional information: Click here to calculate your waist circumference.

Sources: http://www.webmd.com, http://www.nlm.nih.gov, http://content.onlinejacc.org/,

http://www.mayoclinic.com/, http://www.cardiosource.org/acc,

http://www.medicinenet.com/, http://www.webmd.com/diet/calculating-your-waist-circumference,

http://www.nhlbi.nih.gov/redir/disclaimer.htm?http://diabetes.niddk.nih.gov/intro/index.aspx,

http://www.webmd.com/cholesterol-management/ldl-cholesterol-the-bad-cholesterol,

http://www.nhlbi.nih.gov/health/health-topics/topics/ms/diagnosis.html,

http://content.onlinejacc.org/article.aspx?articleid=1770217,

http://www.rd.com/, http://en.wikipedia.org/wiki/,

http://my.americanheart.org/professional/StatementsGuidelines/PoliciesDevelopment/Development/Methodologies-and-Policies-from-the-ACCAHA-Task-Force-on-Practice-Guidelines_UCM_320470_Article.jsp, http://www.heart.org/HEARTORG/,

http://www.cardiosource.org/Science-And-Quality/Journal-Scan/2013/11/201...,

http://www.pace-cme.org/d/849/critical-comment-on-the-accuracy-of-the-new-cv-risk-prediction-calculator, http://www.ncbi.nlm.nih.gov/pubmed/16533939, http://content.onlinejacc.org/article.aspx?articleid=1770217,

http://newsroom.heart.org/news/acc-aha-publish-new-guideline-for-management-of-blood-cholesterol,

http://www.workforce.com/articles/7089-employers-slow-to-address-metabol...

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