Guidelines Back Statins Over HRT To Lower CAD Risk.

Recent clinical trials have failed to show that estrogen use reduces heart disease.

WASHINGTON -- New national cholesterol guidelines favor the use of statin therapy over hormone replacement for reducing the risk of coronary artery disease in postmenopausal women.

"Recent clinical trials have failed to show that estrogen use reduces women's risk of heart disease," Dr. Scott M. Grundy said at a press conference on cholesterol management sponsored by the National Heart, Lung, and Blood Institute.

The recommendations raise from 13 million to 36 million--or 18% of the American adult population--the number of people who should be taking cholesterol-lowering drugs, while placing greater emphasis on early screening and intervention for people who are at risk for developing coronary artery disease.

According to the new criteria, 65 million adults should be making dietary/lifestyle changes to lower their coronary disease risk, up from 52 million under the old criteria.

Statins top the list of cholesterol-lowering therapies, reflecting the overwhelmingly favorable results of five major clinical trials indicating that they safely reduced cholesterol by 25%-50% and dramatically lowered heart disease and all-cause mortality, said Dr. Grundy, chair of the panel that wrote the guidelines and director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas.

In terms of screening, all adults aged 20 and older should receive a fasting lipoprotein profile--including total cholesterol levels, low-density and high-density lipoprotein cholesterol levels, and triglyceride levels--every 5 years.