Cardiovascular guidelines: separate career may help attenuate controversy

Katherine Esposito,Antonio Ceriello,Dario Giugliano,Stefano Genovese

doi:10.1186/1475-2840-13-66

Abstract

The release of recent guidelines for high cholesterol, hypertension and diabetes in the U.S. has been accompanied by great noise and concerns, both in the academic circuits and the lay press. For persons aged 40 to75 years, with LDL cholesterol levels between 70–189 mg/dL and 7.5% or higher estimated 10-year risk, the peril of a global “statinization” has been advocated, predicting a 70% increase of statin use in this otherwise healthy people. A minority of the Eight Joint National Committee panel disagreed with the recommendation to increase the target systolic blood pressure from 140 to 150 mmHg in persons aged 60 years or older without diabetes mellitus or chronic kidney disease. The 2013-American Association of Clinical Endocrinologists algorithm and consensus statement on diabetes has been criticized with particular concerns about transparency, conflicts of interest, group composition, and the abundant use of personal judgment and experience instead of rigorous methodology. Separate careers for experts who collect evidence from persons who write the actual guidelines seems a good opportunity in order to attenuate the noise associated with release of new guidelines, especially those that counter prior practice.

Highlights

The release of recent guidelines for high cholesterol, hypertension and diabetes in the U.S has been accompanied by great noise and concerns, both in the academic circuits and the lay press
On 13 November 2013, from the columns of the New York Times, Abramson and Redberg exhorted healthy Americans to focus on the real factors that undeniably reduce the risk of heart disease and not on statin prevention, as suggested by the new cholesterol guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) [2]
The peril of a global “statinization” of the planet for this grey zone of cardiovascular risk has been put forward [7], predicting an increase of healthy people for whom statins are recommended by nearly 70 percent, and a cumulative global sales of statins approaching $1 trillion by 2020

Summary

Introduction

The release of recent guidelines for high cholesterol, hypertension and diabetes in the U.S has been accompanied by great noise and concerns, both in the academic circuits and the lay press. * Correspondence: katherine.esposito@unina2.it 1Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy Full list of author information is available at the end of the article from the Eighth Joint National Committee (JNC8) [3] are even criticized by members of the very panel that developed them [4].

Results

Conclusion