According to new guidelines, a third of all adult Americans should consider taking cholesterol-lowering statin drugs.
The first such new guidelines in a decade estimated that 33 million Americans – 44% of men and 22% of women – would meet the threshold for taking statins.
The new recommendations were issued by two leading US medical organizations, American Heart Association (AHA) and American College of Cardiology.
The statins are currently recommended for 15% of adults.
The guidelines for the first time take aim at strokes, not just heart attacks.
Under the current advice, statins are recommended for those who have total cholesterol over 200 and LDL, or “bad cholesterol”, of over 100.
The new recommendations place much less emphasis on setting numerical cholesterol-lowering targets for patients.
The advice introduces a new formula for calculating a patient’s risk of heart disease based on such factors as age, gender and race, instead of high cholesterol levels alone.
Heart health panel recommends statins for a third of US adults
“This guideline represents a departure from previous guidelines because it doesn’t focus on specific target levels of LDL, or bad cholesterol, although the definition of optimal LDL cholesterol has not changed,” Dr. Neil Stone, author of the report, said in a statement.
It is thought that more women and African-Americans, who are deemed to be at higher risk of stroke, could find themselves taking statins if they follow the guidelines.
The panel focused on four groups they believe statins would benefit most: people already suffering from heart disease; those with LDL levels of 190 or higher because of genetic risk; older adults with type 2 diabetes; and older adults with a 10-year risk of heart disease greater that 7.5%.
The panel also recommended a “diet pattern” based on vegetables, fruits and whole grains and moderate to vigorous exercise three to four times a week for all adults.
Roughly half of those drafting the guidelines had financial ties to makers of heart drugs.
But panel leaders said that no-one with industry connections was allowed to vote on the actual recommendations.
“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” Dr. George Mensah, of the AHA, told the Associated Press news agency.
Dr. George Mensah said the guidelines were based on solid evidence.
Many of the patents on popular statins, such as Lipitor and Zocor, have expired, with generic versions being offered cheaply.
But Crestor, a statin made by AstraZeneca, remains under patent, with sales of $8.3 billion in 2012.
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A new study suggests that eating apples each day could significantly improve the heart health of middle-aged adults in just one month.
Those who ate a daily apple over four weeks lowered “bad” cholesterol in the blood by 40% – a substance linked to hardening of the arteries.
Taking capsules containing polyphenols, a type of antioxidant found in apples, had a similar, but not as large, effect.
“Bad” cholesterol or low-density lipoprotein (LDL) can interact with free radicals to become oxidized, which can trigger inflammation and can cause tissue damage.
Research leader, Professor Robert DiSilvestro, from Ohio State University, said: “When LDL becomes oxidized, it takes on a form that begins atherosclerosis, or hardening of the arteries.
“We got a tremendous effect against LDL being oxidized with just one apple a day for four weeks.”
The difference was similar to that found between people with normal coronary arteries versus those with coronary artery disease, he said.
The study, funded by an apple industry group, is published online in the Journal of Functional Foods and will appear in a future print edition.
Prof. Robert DiSilvestro described daily apple consumption as significantly more effective at lowering oxidized LDL than other antioxidants he has studied, including the spice-based compound curcumin, green tea and tomato extract.
“Not all antioxidants are created equal when it comes to this particular effect,” he said.
Robert DiSilvestro first became interested in studying the health effects of eating an apple a day after reading a Turkish study that found such a regimen increased the amount of a specific antioxidant enzyme in the body.
In the end, his team didn’t find the same effect on the enzyme, but was surprised at the considerable influence the apples had on oxidized LDL.
For the study, the researchers recruited non-smoking healthy adults between the ages of 40 and 60 who had a history of eating apples less than twice a month and who didn’t take supplements containing polyphenols or other plant-based concentrates.
In all, 16 participants ate a large Red or Golden Delicious apple for four weeks; 17 took capsules containing 194 milligrams of polyphenols a day for four weeks; and 18 took a placebo containing no polyphenols. The researchers found no effect on oxidized LDLs in those taking the placebo.
“We think the polyphenols account for a lot of the effect from apples, but we did try to isolate just the polyphenols, using about what you’d get from an apple a day,” Prof. Robert DiSilvestro said.
“We found the polyphenol extract did register a measurable effect, but not as strong as the straight apple. That could either be because there are other things in the apple that could contribute to the effect, or, in some cases, these bioactive compounds seem to get absorbed better when they’re consumed in foods.”
Still, Prof. Robert DiSilvestro said polyphenol extracts could be useful in some situations, “perhaps in higher doses than we used in the study, or for people who just never eat apples”.
The study also found eating apples had some effects on antioxidants in saliva, which has implications for dental health, Prof. Robert DiSilvestro said. He hopes to follow up on that finding in a future study.