Only people with high cholesterol and a significant risk of heart attack and stroke would be put on statins, under new guidelines released Tuesday by a panel of experts overseen by the American Heart Association and American College of Cardiology.

Statins, considered the most effective drugs to lower cholesterol, and other drugs have long been used to bring down high levels of so-called bad cholesterol. But hitting a target number will no longer be the main focus of national guidelines.


"The new guideline uses the highest quality scientific evidence to focus treatment of blood cholesterol on those likely to benefit most," said Dr. Neil J. Stone, Bonow professor of medicine at Northwestern University Feinberg School of Medicine and chair of the expert panel that wrote the new guidelines.

"This guideline represents a departure from previous guidelines because it doesn't focus on specific target levels of low-density lipoprotein cholesterol, commonly known as LDL, or 'bad cholesterol,' although the definition of optimal LDL cholesterol has not changed. Instead, it focuses on defining groups for whom LDL lowering is proven to be most beneficial."

The new guidelines recommend moderate or high-intensity statin use for patients with high levels of bad cholesterol, but also for those with heart disease, those with Type 2 diabetes who are age 40-75 and those with a 10-year risk of heart disease of 7.5 percent or higher age 40-75.

This may mean higher doses of statins for some patients, and eliminating other kinds of drugs. Others, particularly younger patients, may not be prescribed statins at all.

The groups said the review was undertaken because of the rising rate of cardiovascular disease, the leading cause of death in the country. It emphasizes a healthy lifestyle in addition to better treatment of disease.

The guidelines don't take into account every scenario and still rely on a doctor's judgment, but they fill in some of the gray area, said Dr. Michael Miller, a professor in the University of Maryland School of Medicine's Departments of Medicine, Epidemiology & Public Health.

Miller, also the director of the University of Maryland Medical Center's Center for Preventive Cardiology, said the new guidelines call for statin use only for patients who are viewed at sufficiently high risk of a heart attack or stroke in the next 10 years. A calculator would be used to assess that risk and take into account such things as age, smoking and high blood pressure.

He said, however, that some of his patients who don't fall into the categories outlined in the guidelines are responding well with moderate use of statins. He said he wouldn't "rock the boat" by changing their therapy – especially because the new guidelines are based on trials lasting two to five years rather than the one to two decades that he has treated them.

"It would become utterly chaotic if we need to revisit these changes in all of our patients," he said. "So for my new patients, I will be following the new guidelines but for my longer treated patients who are doing well, I may have them maintain the course."