While most of stories focused on changes to the guidelines and the call for intensive drug treatment, several articles focused on the challenges many clinicians will face in lowering cholesterol. Chicago Tribune staff reporters Judith Graham and Bonnie Miller Rubin recount how implementing medical experts' new advice isn't likely to be easy.3

"Most physicians haven't aggressively promoted previous cholesterol standards, and more than two thirds of patients who should cut their cholesterol aren't meeting earlier goals," report Graham and Rubin. "Also, at about $100 a month, cholesterol-reducing drugs are expensive, and the prospect of a lifetime of therapy is problematic for many patients."

In addition to discussing some of the side effects associated with higher doses in some patients, the Tribune reporters note that the frequently shifting guidelines and the constant stream of health warnings baffle many consumers. It doesn't help that doctors can't say where the stopping point will be, Graham and Rubin write.

"The question ishow low is all this going to go? The truth is, we don't know," Dr Allan Zelinger (Advocate Christ Medical Center, Oak Lawn, IL) is quoted by the Chicago paper.

However, after two days to digest the new guidelines, Delthia Ricks and Roni Rabin of Newsday report that of the nine members of NCEP expert panel, six had received grants or consulting or speakers' fees from the drug companies that produce statin medications.4 Such financial links to drug companies were printed in the Journal of the American Medical Association when the original guidelines were published three years ago, according to the reporters.

"We now understand, in the current climate, it is wise to make that information [researchers' financial connections] as transparent as possible," Dr James Cleeman (National Heart, Lung, and Blood Institute, Bethesda, MD) told Newsday. He said the omission of financial disclosure was an oversight and the panelists' pharmaceutical-company relationships will be posted on the NHLBI website within the next few days.

"It should have been there," Dr Steven Nissen (Cleveland Clinic, OH) told Newsday, referring to financial-disclosure information, but added, "It is hard to work in the lipid field and not have gotten a grant from a pharmaceutical company."

"Certainly if it were me, I would have disclosed it," continued Nissen. "But it is important to point out that these are reputable people. They are leaders in the field, people of integrity."

The Newsday article notes that Dr H Bryan Brewer (National Heart, Lung, and Blood Institute, Bethesda, MD), one of the guidelines' authors, was the subject of a recent letter to the director of the National Institutes of Health from a consumer watchdog, Public Citizen's Health Research Group. The advocacy organization charged that Brewer had failed to disclose ties to AstraZeneca.

In true Forbes fashion, the financial publication noted that the new guidelines are "a gift" for Merck and Pfizer, makers of the two best-selling statins.5 Under the previous guidelines, Forbes reporter Matthew Herper notes that as many as 36 million Americans should be taking statins, but only 11 million do. Dr Christopher Cannon (Brigham Women's Hospital, Boston, MA) is quoted in the article as saying that now as many as 50 million Americans should be on the drugs.

The new guidelines should encourage doctors to use stronger drugs, says Forbes, and as result will be a big boost for atorvastatin (Lipitor^®, Pfizer). Rosuvastatin (Crestor^®, AstraZeneca) could also benefit but may be held back because it does not have the same track record of safety as atorvastatin, writes Herper.