If you are part of the one in three adults in the United States who have high levels of LDL or “bad” cholesterol, you are at greater risk for a heart attack or stroke.
There is no one-size-fits-all treatment for high cholesterol. Recently, the American Heart Association and the American College of Cardiology released new cholesterol guidelines. Here’s how each of these new guideline recommendations might affect you.
- A personalized approach to managing cholesterol.
Everyone is different and so not all LDL numbers reflect the same risk of a dangerous blockage or hardened artery. Under the new guidelines doctors are encouraged to factor in risks such as high blood pressure, diabetes, smoking and family history of heart disease in deciding which patients should be prescribed statins (a class of drugs often prescribed to help lower cholesterol levels in the blood, thereby preventing heart attacks) to bring down their LDL number. The new guidelines also highlight additional risk enhancing factors that should be considered, including:
- Positive family history
- Specific racial/ethnic backgrounds
- Certain health conditions such as metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or preeclampsia and high lipid biomarkers
In most cases, when high cholesterol can’t be controlled by diet or exercise, statins are typically prescribed used to lower LDL cholesterol levels and cardiovascular disease risk.
- New pharmaceutical interventions.
One of the biggest updates in the new guidelines is the recommendation for more aggressive use of statins, as well as the more extensive use of a newer class of drugs known as PCSK9 inhibitors, to help control bad cholesterol for those with established cardiovascular disease. PCSK9 inhibitors are used target and inactivate a specific protein in the liver. Inactivating this protein can dramatically reduce the amount of harmful LDL cholesterol circulating in the bloodstream.
This recommendation of prescribing statin and PCSK9 inhibitors is for those in the highest risk group. For example, if your bad cholesterol level is 70 or more, the new recommendations specify that beyond statins, you should also be given a drug called ezetimibe. Ezetimibe lowers LDL cholesterol levels by reducing cholesterol absorption in the small intestine. If after four to 12 weeks ezetimibe when coupled with healthy diet and lifestyle changes is ineffective, then a PCSK9 inhibitor might also be prescribed.
While PCSK9 inhibitors work differently from statins, both types of drugs increase the function of LDL receptors on the surface of the liver, helping the organ to pull more of the bad cholesterol out of your bloodstream.
- Additional testing for those with intermediate risk.
When determining your likelihood for heart attack or stroke your doctor should weigh your LDL score against additional risk factors mentioned above using a risk calculator. As part of guideline updates, the risk calculators have also been updated to yield more conservative results by moving more patients from low to intermediate risk.
If your risk shows a borderline result, another major update may come into play to help your doctor select the right course of preventative action. If you have higher cholesterol levels than suggested but a lesser cardiovascular risk status, the recommendation of a coronary artery calcium (CAC) test is suggested. This test is an ultrafast CT scan, that your doctor to see white spots or calcifications in the arteries. If you do have a certain percentage of plaque buildups, you’ll be moved to the “intermediate risk” category, and potentially be prescribed a statin drug to help lower your cholesterol levels and potential risk for a cardiac event.
“The guidelines regarding cholesterol management reinforce the idea that treatment strategies need to be catered and individualized for each patient,” said David Shenouda, DO, cardiologist. “What we are discovering in cardiovascular medicine today is that reducing cardiovascular risk is not necessarily done by simply lowering cholesterol numbers. There is a growing body of evidence that cardiovascular disease is prevented by lower cholesterol and lower vascular inflammation. Statin type medications provide an intrinsic vascular anti-inflammatory effect that helps to reduce cardiovascular risk even in patients with normal cholesterol values,” Shenouda said.
These new guidelines are simply a treatment road-map for physicians to help them examine their patients’ risk factors and personalize a care plan for each patient. If their patients can understand and manage their risks, they’ll be able to living longer, healthier lives.