New guidelines offer new approach for managing high cholesterol : NPR
Doctors say patients should have a lipoprotein(a) test along with other screening tests, under new guidelines for cholesterol management.
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New guidelines for cholesterol management call for more aggressive prevention and earlier treatment, including recommending that all adults be tested for lipoprotein(a), a genetic risk marker for heart disease.
The American Heart Association and the American College of Cardiology released updated guidelines Friday, which aim to expand the tools doctors use to assess cardiovascular risk. Cardiovascular disease is the leading cause of death among men and women in the United States.
“We know that 80% or more of cardiovascular disease is preventable and that high LDL cholesterol, sometimes called ‘bad’ cholesterol, is a significant part of that risk,” Dr. Roger Blumenthal, a cardiologist at Johns Hopkins in Baltimore who chaired the guideline writing committee, wrote in a statement.
But knowing your LDL levels alone may not be enough, Blumenthal said. Measuring additional biomarkers, he wrote, “can provide a more complete picture of a person’s cardiovascular risk and help inform decisions about whether lipid-lowering therapy is needed as early as possible.”
Among the new recommendations is a single lipoprotein(a) test for all adults. It’s a simple blood test that’s widely available, and more and more primary care doctors are offering it as part of preventive care.
Because lipoprotein(a) is genetically determined and relatively stable throughout life, the test generally only needs to be performed once, ideally in early adulthood. High levels signal a hereditary risk of heart attack, stroke and other cardiovascular diseases.
The guidelines also call for broader use of the coronary calcium score, which is a noninvasive test that measures calcified plaque in the arteries. They also encourage health care providers to use a risk assessment tool called PREVENT, which can project a patient’s heart disease risk over 10 and 30 years to help guide decisions about starting treatment.
Cholesterol-lowering drugs, called statins, remain the first-line treatment for high cholesterol. Under the new framework, drugs could be considered even for patients at relatively low risk, if their overall lifetime risk profile supports it.
“It’s a sea change,” said Dr. Steven Nissen, a preventative cardiologist at the Cleveland Clinic. “What matters is the risk a person runs over their lifetime.”
“These new guidelines will allow more people to be treated sooner,” Nissen adds. Because generic versions are available for all major types of statins, the drugs are relatively inexpensive. Nissen says he pays about $3 a month for his statin prescription.
An estimated 25% of adults in the United States have high levels of low-density lipoprotein cholesterol, or LDL, which increases the risk of heart attacks and strokes.
Nissen says the guidelines will affect millions of people and lead to many more being treated with statins and other drugs that can lower LDL cholesterol. He points out that an earlier and more intensive preventive approach could lead to a significant overall reduction in heart attacks, strokes and cardiovascular disease.
The guidelines also highlight the benefits of changing daily behaviors and habits, including regular physical activity, avoidance of tobacco products and healthy sleep habits. “The cornerstone of good cardiac prevention is diet and exercise,” says Leslie Cho, preventive cardiologist at the Cleveland Clinic.
The guidelines are published in the journal Traffic, and In JACCthe Journal of the American College of Cardiology.
