ACC.14: Survey finds more docs hate than like lipid guidelines

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WASHINGTON, D.C.—Physicians appear split on the value of the new lipid guidelines released in late 2013. In a vote on March 30 at the American College of Cardiology (ACC) scientific session, 36 percent of respondents chose “hate it” and 34 percent “like it.”

Many of the others admitted they had not read them.

The late session was designed to help physicians better understand the American Heart Association/ACC preventive guidelines, which were designed to reduce the risk of atherosclerosis in the U.S. The guidelines veer from previous recommendations by eliminating cholesterol target goals, calling for high-intensity statins in certain patient populations and introducing a new risk calculator that includes stroke and broader patient populations.

About a third of the roughly 150 respondents in the informal survey were cardiologists, with primary care physicians and other specialties making up the rest. They were evenly distributed between working in private practice, group practice, medical centers and other structures.

Neil Stone, MD, of Northwestern University Feinberg School of Medicine and chair of the guideline committee, explained that the guidelines are not a mandate but rather were designed to inform clinical judgment. “I have a tough task,” he recognized. “I have to persuade you that what we said is a valuable place to start in your assessment and treatment of patients to reduce atherosclerotic cardiovascular risk.”

Stone reviewed the process behind creation of the guidelines, which based most recommendations on randomized clinical trials with hard outcomes. He emphasized the recommendation to engage in physician-patient discussion before initiating statin therapy and repeated that the evidence doesn’t support using specific low-density lipoprotein (LDL) cholesterol goals. But he added physicians still needed to measure LDL cholesterol, monitor adherence and follow up to ensure the treatment is safe and tolerated.

“You are looking for therapeutic response and adherence,” he said.

The new approach is patient-centered. “The important thing is physician-patient discussion,” Stone said. “Evidence needs to meet clinical judgment needs to meet patient preference.”

Panelist John J.P. Kastelein, MD, PhD, of the Academic Medical Center in Amsterdam, challenged the move to drop cholesterol level targets. He said the European guidelines differ with U.S. guidelines on that point. Also, most European patients are prescribed lower dose statins.

“To get patients to higher dose atorvastatin you need targets,” Kastelein said. “This is the clinical reality in Europe. … I think that targets, in fact, empower patients. We have tried to teach the targets for the last 10 years and now that they finally know them you want to discard them.” 

The ACC and AHA presidents discussed the new guidelines in a Q &A with Cardiovascular Business. The article is available here.