Tag Archive for: 2018 Guidelines on Cholesterol

2018 Cholesterol Guidelines and Evidence-Based Medicine

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I was encouraged by the AHA’s new cholesterol guidelines for one reason: the promotion of a joint decision between patient and physician on a treatment plan if one was necessary. That’s the basic tenet of evidence-based medicine: any and all treatment plans should take into consideration the wishes and desires of the patient. Many factors can go into that—the age and current physical state of the patient, the financial cost of treatment, and the physical cost of treatment compared to the potential benefit.

The only concern I have is this: will that discussion actually take place as intended or will it be a one-sided conversation with the physician making the decision for the patient? Will the physician listen or ignore the patient’s views? Paula and I have a great primary care physician and specialists who always listen to us, but I know it’s not that way everywhere. It’s easy to say, “If he won’t listen, just find another doctor,” but that isn’t always an option in rural areas or if your health insurance limits your choice.

The physician side of evidence-based medicine is just half the story. I’ll give you my thoughts on the rest of the guidelines on Saturday.

What are you prepared to do today?

Dr. Chet
Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.

 

AHA’s 2018 Guidelines on Cholesterol

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Here’s what the American Heart Association announced this past weekend: a 120-page research-based paper on new cholesterol guidelines and how the guidelines were developed. The paper was five years in the making, involved twelve medical and physician associations, and includes ten documents to explain and summarize what the guidelines say. For the foreseeable future, these will be the guidelines used by physicians trying to reduce the risk of cardiovascular disease.

The guidelines focus on control of LDL-cholesterol in combination with the state of the individual: those with and those without diagnosed disease. Primary prevention is for those who’ve not been diagnosed with atherosclerotic cardiovascular disease (ASCVD). Secondary prevention applies to those who have been diagnosed with ASCVD. The flow charts for treatment plans are complicated, even when isolated and presented on individual pages.

What I liked the most is that management of CV risk begins with a conversation between the physician and patient. The discussion revolves around risk factors, both lifestyle and the test results. The goal is to come to a consensus for treatment if a person’s CVD risk is high. What does that treatment involve? We’ll take a look on Thursday.

The Insiders Conference Call is tomorrow night. If you’re not an Insider yet, you still have time to join and take part in the call. I’ll be covering the latest research on omega-3s and vitamin D as well as answering your questions.

What are you prepared to do today?

Dr. Chet

 

Reference: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000625.