The current guidelines for lipids and cholesterol in the U.S. involve the Heart Risk Calculator.

The guidelines change about every 6-8 years. This is the fourth set of guidelines that I have worked with since I started medical school in 1989.

The current guidelines say that four groups of people should lower their cholesterol by lifestyle changes or by taking a statin. The lifestyle changes are recommended first. The Calculator is misleading in that if you score more than 7.5% ten year risk, it says you should be on a statin. It ignores lifestyle changes.

The four groups:
1. All people with known coronary artery disease.
2. All people with diabetes.
3. All people with an LDL over 190.
4. All people with a Heart Risk Calculation over 7.5% ten year risk.

If a person is not in category 1-3, I run the Calculator. It addresses age 40 to 70. My patients range from 1% to 31%. This estimates the ten year risk of sudden death, heart attack, coronary artery disease and stroke.

A colleague says that it puts all women 60-70 years old on a statin. I fill in the numbers in clinic, get a result, and then back click and mess with it: a person today dropped from a risk of 9.5% to 5.6% if he stops smoking.

The statins lower LDL by 25-30%, beating lifestyle. Neurologist put people with TIAs and clot (not bleeding) strokes on statins.

The current guidelines differ vastly from previous ones, which gave LDL goals for low, medium and high risk patients. This is faster. The entire guideline is about 46 pages, leaving me unsure if it is more accurate.

People ask about their "ratio". The ratio is four guidelines ago. We don't care any more. Medicine keeps changing, guidelines galore.