Tuesday, February 07, 2006

Should we review the NCEP guidelines?

The strory of "Statins" does not want to go away. The latest (February) issue of Medical Tribune carried a front page article entitled "New guidelines neede for cholesterol management". Dr Forrester's views here is balanced and very reasonable when compared to the current day NCEP guidelines, which seem to want us to lower LDL-cholesterol level to 70mg%, as a blanket guideline.

I have always suspected that the powerful pharmas, may have had something to do with the NCEP3 guidelines which ask us to just blindly push LDL-cholesterol levels as low as possible. We are concerned about that approach as it means using high doses of "superstatins", and these superstatins have their own side-effects. On the other hand, Dr Forrester ask us to first estimate CVS risk using the Framingham Coronary risk score. The higher the Framingham CVS risk, the lower should be the LDL-cholesterol, and with a low enough Framingham risk score, you may not even need statins (just lifestyle modification). That makes sense.

In other words, the ASCOT study, both the BPLA arm and the LLA arm, teach us that we must see the patient as a whole and fit the target LDL-cholesterol level to the patient, on the basis of his coronary risk.

Just to reiterate :

Coronary 10years riskTarget of LDL-cholesterol
>20% 70mg%
10-20% 130mg%
<10%>lifestyle modification

This view seem to be a balanced view. And not to forget that LDL-cholesterol is but one risk factor in the fight against CAD. There is always the inflammation factor. Perhaps the NCEP guidelines in future should also include a mention of maintaining hs-CRP to <1mg%.

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