The next treatment paradigm in cardiovascular prevention?

New treatment guidelines can initially be controversial as the evidence and methods they are based on might contradict established paradigms. [...]the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults1 was initially negatively received. Lowering cholesterol with more intensive therapy is also supported by findings that generic statins are cost-saving or highly cost-effective even for primary prevention in patients at low risk of cardiovascular disease.10 sturti/Getty Images The main limitation of the analysis by Brunner and colleagues5 might be the assumption of the amount of net risk-reduction benefit for atherosclerotic cardiovascular disease, projected from a 50% reduction in non-HDL cholesterol. Only long-term cholesterol-lowering treatment is likely to approximate the relative risk reduction observed from naturally occurring non-HDL or LDL cholesterol concentrations.11 However, the Cholesterol Treatment Trialists Collaborators' meta-analysis of statin trials12 shows that statin therapy reduces the relative risk of cardiovascular disease more in people with a 5-year risk of vascular events of less than 10% than in those with a higher risk.12 Because risk is largely driven by age, greater risk reduction could therefore be expected in younger adults.