So this is circulating today. Now they basically are saying that "if you're at all at risk for heart disease" -- which is basically everyone...eventually. You get statin treatment. So I fully expect my doctor will now be recommending I start these as daily pills... I sort of hate the idea of adding more pills to my routine "just cause".
Maybe thats a dumb response, but I feel like the approach is both good and bad. Good in the sense that over treating to achieve a target was clearly bad practice, and this removes much of that. But forcing patients onto medications when they are doing ok without them seems like a big handout to the pharmaceutical industry. I suppose the problem boils down to how to effectively determine "doing fine". Previously the ldl targets were the indicator. Now they are stepping back from quantified rules, and instead moving in the direction of "spray-n-pray"... neither seems right. I can't tell which I hate more from a theoretical perspective. But from a personal one, I do hate the notion that working my ldl down to help stay off medication is now... moot.
Someone pass the bacon.
Even though statins are basically all generic (cheap) now, and several still-in-patent (expensive) medications are effectively being ruled out as they don't show improvement to heart outcomes, the very notion that you should get used to taking daily pills if you're a healthy person makes you more likely to accept that (possibly unneeded) treatment option in the future.
They say in the same breath "heart health should start at home with a healthy diet and exercise plan" -- and then "but regardless of how healthy you are, you should take our magic pills"... it feels wrong.
That said, treating to an arbitrary number without regard for heart outcomes (ldl > 100 == bad) wasn't resulting in good practices either. (witness drugs that are designed to lower cholesterol, but which showed no improvement in heart health)
It seems to me whats missing is a more effective marker/signal of heart health trajectory. If I accept that cholesterol numbers are a poor signal. And that there is therefore a distinct lack of available good signal. The practice you're left with is effectively whats being recommended. Act like a life-insurance company: pool risk profiles, and handle them all the same.
Pass me the pills.