Many leading cardiologists say the credibility of new cholesterol guidelines released this month is shattered, raising questions about what kind of evidence should be used to direct medical practice and even which guidelines to believe, The New York Times
The release of the guidelines, at the annual meeting of the American Heart Association on Nov. 14, was supposed to be a crowning achievement based on the most rigorous scientific evidence on how to prevent heart attacks and strokes, which kill one out of every three Americans. But, instead, it only led to confusion and a backlash against cholesterol-lowering efforts.
"This was a catastrophic misunderstanding of how you go about this sort of huge change in public policy," Steven Nissen, M.D., a Cleveland Clinic cardiologist and past president of the American College of Cardiology, told the Times. "There will be a large backlash."
Critics say guidelines were based on randomized controlled clinical trials, but ignored other strong data that would have led to different conclusions. The drafting committee also announced the changes without allowing for a public debate.
"A lot of people expect they can come up with guidelines as a pure scientific discourse and present them to the public," said J. Sanford Schwartz, M.D., a committee member and a professor at the University of Pennsylvania, told the Times. "That’s what we did here, but the world has changed."
The guidelines shocked many doctors by recommending they stop their decades-long practice of monitoring levels of LDL "bad" cholesterol, after patients begin taking statin medicines. Harvard medical professors also noted a new online risk calculator that greatly overestimated the risks of having a heart attack or stroke.
In the wake of the controversy, some experts have raised the idea of a collaborative international effort to devise guidelines. Europe has its own set, but countries within Europe use different risk calculators, said Michael Lauer, M.D., of the National Heart, Lung, and Blood Institute.
"The way it works in Finland is different from the way it works in Spain," he told the Times.
Added Seth Martin, M.D., at Johns Hopkins in a post on the Website of the American College of Cardiology: "Couldn’t we do this better as a worldwide team than on our own?"