What’s New In Cholesterol Treatment?
Do you ever wonder why cholesterol is important? We all wish we had the power to predict the future. While physicians do not have a crystal ball to see into the future, we use medical research to try to tell each patient what diseases they are at most risk of developing. Then we try to give advice on how to avoid those diseases. One of the major risk factors for cardiovascular disease, the leading killer of Americans, is high cholesterol. Recently a long awaited report on how to manage cardiovascular risks, chiefly cholesterol, was published. The American College of Cardiology and the American Heart Association are two premier organizations in the United States whose goal is to prevent cardiovascular disease. They collaborated with the National Heart, Lung and Blood Institute (NHLBI) to write guidelines which help calculate cardiovascular risk for patients. These guidelines are the closest thing we have to a crystal ball. Those at greatest risk should pay the most attention to lowering their total and bad cholesterol levels.
What data do you need to predict cardiovascular risk?
a) If you are between age 20 to age 79, schedule an appointment with your physician to discuss your cardiovascular risk factors.
These are: 1) total cholesterol 2) HDL (good) cholesterol and LDL (bad) cholesterol 3) blood pressure 4) diabetes 5) family history of heart disease or stroke
- Type in your age, sex, race, total cholesterol, HDL cholesterol, systolic (top number) blood pressure, whether you are being treated for high blood pressure, diabetes, and if you are a smoker.
- The calculator will automatically calculate your 10 year risk of developing cardiovascular disease as well as your lifetime risk of developing cardiovascular disease. The guidelines recommend that lifetime risk be calculated for those 20-39 and 10 year risk for age 40 and above.
- If your 10 year risk is 7.5% or above, it is recommended that you take a statin, one of the cholesterol lowering drugs that is an HMG Co reductase inhibitor, such as Lipitor or Crestor. These medications have been shown in many studies to lower the risk of heart attack and stroke.
Some caveats to the above:
a) Lifestyle changes such as eating a low fat, low cholesterol diet and regular aerobic exercise should always be the first step in lowering cholesterol. Often it is helpful for patients to see a nutritionist to review their current diet and put in place new dietary habits.
b) If you have had a heart attack or coronary artery disease detected or if you have diabetes, the guidelines suggest you be on statins (such as Zocor, Lipitor, or Crestor) regardless of other risk factors.
c) If your risk is less than 7.5% over 10 years but you have any of the following risk factors, your risk assessment would be adjusted upwards:
- A positive premature family history for heart disease (a first degree relative male less than 55 years old or a first degree relative female less than 65 years of age).
- A blood test called the CRP (C-reactive protein) greater than or equal to 2.
- Coronary artery calcium score (done on a CT scan of the heart)of greater than 75th percentile for age/sex/ethnicity.
- Ankle Brachial index (ABI) (a measurement of leg artery circulation) less than 0.9.
d) The new risk calculator has made headlines for being controversial as some physicians feel it overestimates cardiovascular risk and is over aggressive at recommending medications, but it is the best and most recent guideline that we have.
In summary, if you are above age 20, it is good to see your physician and discuss your cardiovascular risks. They can give you a risk score that is worthwhile thinking about for the future. Remember that lifestyle changes, namely diet and exercise, which is the focus of this blog, are the cornerstone for improving your cholesterol – increasing HDL and lowering total and LDL – and achieving good heart health!
ACC/AHA Publish New Guideline for Management of Blood Cholesterol
A Pragmatic View of the New Cholesterol Treatment Guidelines, New England Journal of Medicine, 2014; 370(3): 275-278.