Lowering Risk Without Lowering Cholesterol: Implications for National Cholesterol Policy

Current recommendations for the treatment of hypercholesterolemia include drug therapy for persons at sufficiently elevated risk for coronary heart disease. However, no guidelines incorporate the effects of alternative interventions that decrease risk for coronary heart disease but are not used specifically to alter blood lipids. We did a simulation study to estimate the number of hypercholesterolemic adults who would continue to exceed a high-risk threshold after receiving aspirin, antihypertensive medication, and estrogen-replacement therapy. We found that of all persons who are currently candidates for hypolipidemic medication because they are at high risk for coronary heart disease, 6 to 8 million would no longer have this therapy recommended if the abilities of alternative interventions to reduce risk were considered. Pharmaceutical cost savings associated with alternative interventions range from $3 to $4 billion per year. Current guidelines should be revised to account for this effect.