2013.11.12 13:29
New Guidelines for Cholesterol Control and Controversy
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Guidelines are only guidelines.
Practitioners should take these new guidelines into consideration in his clinical judgement
in each individual patient. He doesn't have to adhere to them.
I believe there will be some changes in the clinical practice but not too much.
I believe the old guidelines with specific target numbers did a lot of good in spite of lack of published
concrete evidence. I said this with my own clinical experience following coronary heart disease patients
for many years up to some forty years. I have so many patients who have proved this point.
I was invited to the 102nd birthday party of one patient whom I subjected to CABG in 1975.
My patient and former dentist of mine, age 86, whose two older brothers died of CHD under my care,
and who has familial hypercholesterolemia and became my patient in his forties is still free of CHD
and is leading active life style.
I have a former school teacher who suffered an MI in his early thirties and was found to have severe mixed hyperlipidemia
with triglyceride over 1000 and cholesterol around 300. This was in 1970's.
I had him undergo partial intestinal bypass by Dr. Buckwalter at University of Minnesota as part of clinical trial
sponsored by NIH at that time. About 10 years ago I had his intestinal bypass reversed because of persisting diarrhea
and available anti lipid drugs. He is still leading active full life in his late 70's.
These are only a few examples of what tight lipid control even beyond old guideline numbers can do in preventing
and reversing CHD.