AHA's new guidelines should leave ashes in Pharma’s mouth

Cardiology news this week should leave some ashes in pharma’s mouth.  The American Heart Association and the American College of Cardiology issued new guidelines for managing patients’ cholesterol.

For several decades patients were prescribed medications, mainly statins, to alter their cholesterol levels based almost entirely upon readings for total cholesterol and the LDL and HDL “fractions.”  Under the financial lure of research grants from pharma companies, these professional societies and their esteemed Key Opinion Leaders kept making the target cholesterol levels more difficult to achieve.  This had the effect of pushing physicians to prescribe ever stronger statins to a larger number of people.  In the process pharma companies earned billions in sales for their branded statins — Lipitor, Zocor, Crestor and others.

Under the new guidelines, the same target cholesterol levels don't apply to everyone and pharma's longstanding admonition to physicians, the-lower-the-better, is revealed as the promotional dodge it's always been.  While a set of cholesterol numbers in one person may warrant statin therapy depending upon that person's history, the same numbers in someone with a different history may indicate that no drug therapy is needed.

Ironically, some researchers anticipate that more people will become eligible for statin therapy under the new guidelines, although the fact that the top-selling statins, except for AstraZeneca's Crestor, are now off-patent won't benefit the branded pharma companies.

This situation is not one where pharma companies promoted their statins for twenty-plus years under the best guidelines that were in force at the time but now are obsolete.  Most office-based cardiologists always knew that cholesterol levels represented just one of several factors to be taken into account when determining the course of treatment.  It's just that the increasingly demanding target levels mandated by the professional societies, under pharma's financial lures, kept raising the legal liability concerns among garden variety cardiologists and encouraged them to spread more statins around.

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