The American Heart Association (AHA) and the American College of Cardiology (ACC) on Tuesday released new guidelines for statins that are expected to reshape the use of the cholesterol-lowering medications.

Under the new criteria, the number of adult patients considered likely to benefit from a statin prescription increases from 15.5% from 31%. 

Four questions will determine risk factors

The new guidelines focus on risk factors rather than cholesterol levels.

"For many years, the goal was to get the 'bad' cholesterol levels—or LDL levels—below 100," says Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic. He explains, "Those targets have been completely eliminated in the new guidelines, and the threshold for treatment has been eliminated."

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Instead, the guidelines recommend using specific risk factors to identify patients who should receive statins and patients who should simply make lifestyle changes.

Specifically, answering yes to any of the following four questions merits a statin prescription:

• Do you have heart disease?
• Do you have Type 2 diabetes and are you between ages 40 and 75?
• Do you have a bad cholesterol level higher than 190 mg/DL?
• Is your 10-year risk of heart attack or stroke greater than 7.5% and are you between ages 40 and 75?

Patients who do not meet any of the four criteria should be able to manage their cholesterol levels with lifestyle changes, according to the guidelines.

In addition, the new guidelines move away from policies that relied on low doses of statins combined with other cholesterol drugs. Instead, the guidelines recommend higher doses of statins, as well as healthy lifestyle changes, in an effort to eliminate the need for other cholesterol drugs.

An enormous shift

"The likely impact of the recommendations is that more people who would benefit from statins are going to be on them, while fewer people who wouldn't benefit from statins are going to be on them," says Neil Stone. Stone is a professor of preventive cardiology at Northwestern University's Feinberg School of Medicine who chaired the committee that created the guidelines.

Experts say the new policies represent a major change for heart care.

"This is an enormous shift in policy as it relates to who should be treated for high levels of cholesterol," says Nissen. However, he says it will likely take physicians years to change their practices (Sloane, CNN, 11/12; Szabo, USA Today, 11/12; Jaslow, CBS News, 11/12; Kolata, New York Times, 11/12).