authors of the guidelines have since rushed to defend their recommendations. During the annual conference of AHA organised in Dallas last week, Reuters quoted Dr Sidney Smith of the University of North Carolina as saying, “We intend to move forward with the implementation of these guidelines... If we think there is something that will make them better, you can count on that we’ll do it.” Dr Smith is a former president of the AHA and the executive chairman of the guidelines committee.
The guidelines are based on evidence gathered from medical research published between 1990 and 2012 and one criticism that has emerged is that more recent studies should have been incorporated before arriving at such sweeping recommendations.
With no Indian guidelines in cardiovascular diseases, doctors here have been following a combination of American, European and Canadian guidelines. Most Indian doctors say they will wait for implementation of the guidelines in the West.
AIIMS cardiology HoD Dr V K Bahl said, “Till now, doctors were advised to continue giving statins while monitoring levels of LDL. The drugs were only prescribed for people with high LDL. The new guidelines are essentially telling clinicians to give statins in moderate to high intensity and not constantly check cholesterol levels.”
Dr Bahl said the guidelines have advised against prescription of additional non-statin category drugs that are often given as “added measures” to “improve outcomes of statins”. “If LDL levels don’t go down despite giving statins, doctors prescribe other categories of drugs such as fenofibrates. These drugs often increase the side effects associated with statins, and the guidelines have said these additional drugs have no role in controlling cardiac episodes,” Dr Bahl said.
The authors note in the guidelines, “Non-statin therapies... do not provide acceptable ASCVD risk reduction benefits compared to their potential for adverse effects in the routine prevention of ASCVD.”
The guidelines have identified four groups, as “statin benefit groups” — those with a history of cardiac episodes; those with “primary elevations” of LDL cholesterol with no other indications of cardiovascular disease; those between 40 and 75 years old diagnosed with diabetes and with moderate to high