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New Cholesterol Guidelines — A Tale of Two Countries

November 18, 2013

The American Heart Association/American College of Cardiology just published new guidelines for screening and treating cholesterol.

In some ways these guidelines are more like the British guidelines. Instead of setting up doctors and patients to fail by calling for certain cholesterol number targets as in the old U.S. guidelines (LDL level below 100, e.g.), they instead focus on putting higher risk patients on drugs called statins and then not worrying about the new cholesterol number under treatment. It’s more simply: high risk, take statin; low risk, don’t take statin.

Of course these guidelines don’t come without controversy. Some estimate the number of adults recommended to take statins will double. Others criticize the Excel spreadsheet that comes with the guidelines as exaggerating the true risk of developing heart disease by 75% to 150%.

The other factor that has gotten less press is the definition of high risk, even if the heart disease calculator is accurate. The AHA/ACC definition of high risk is a greater than 7.5% of developing symptomatic heart disease (not death) in 10 years. The British define high risk as a 20% chance in 10 years.

This is clearly a huge difference and it speaks to the underlying cultures of the two countries. The U.S. ologists and the large foundation that supports them err on the side of assuming more is better, and any theoretical benefit — no matter how high the cost — is worth it. The British err on the side of being sure that the benefits of drug therapy is clearly greater than the risks of adverse events, and they take costs into consideration. Some people are simply at too low a risk to justify the expense and hassle of a lifetime of drugs.

And as a reminder, here is a link to a post I wrote earlier explaining why screening and treating people for high cholesterol does not save money, even in the long run.

The British people and their government are willing to tell its healthcare industry that it can’t have everything it wants, and that other societal goods improve health as well. This is one of the many reasons the British people enjoy better health at less than half the cost of the U.S.

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2 Responses to New Cholesterol Guidelines — A Tale of Two Countries

  1. Alice Robertson on November 27, 2013 at 9:30 am

    Are you joking about the Brits enjoying better health?:) Having lived there that’s far, far from true. The NHS may occasionally make some good decisions, but you don’t want to get sick there. They just die quicker than we do.

  2. Richard Young MD on November 29, 2013 at 1:14 pm


    I’m not joking. A few facts: the UK has a higher rate of stroke and cancer death rates, but a lower rate of heart attack, suicide, and motor vehicle death rates. The UK has higher life expectancy than the U.S. for both men and women, a higher number of saving potentially preventable lost years of life, and a lower infant mortality rate. The people of Britain are less likely to say that their system is broken and needs a complete overhaul than Americans.

    If you would like to read more healthcare facts about the two countries and other major developed countries, here is a thorough document: http://www.oecd.org/els/health-systems/49105858.pdf

    I suspect you applied a more = better American attitude about healthcare during your time in the UK, which they don’t subscribe to. By being less aggressive across the board, their system is much less likely to harm people by over-testing and over-treating them.

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