The American Heart Association and American College of Cardiology recently updated the guidelines for the use of cholesterol-lowering medications to help reduce the risk of heart disease. They now allow for greater personalized care.
“The new guidelines are more specific as to when physicians should prescribe cholesterol-lowering drugs like statins to patients,” says Todd Hitchcock, MD, a cardiologist at Scripps Clinic Carmel Valley. “This will help us gain an even better and more comprehensive understanding of each patient’s risk.”
The recommendations go well beyond taking into account cholesterol levels, and other traditional risk factors, such as smoking, high blood pressure and high blood sugar. They now also take into consideration such risk factors as family history and ethnicity, as well as health conditions such as metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or pre-eclampsia and high lipid biomarkers.
“The new guidelines should prompt a more in-depth discussion between physicians and patients,” Dr. Hitchcock says.
Cholesterol is a waxy substance that comes from two sources. Your body naturally produces all the cholesterol it needs and circulates it through the blood. Cholesterol also is found in foods from animals that are high in saturated and trans fats, such as red meat and dairy products. When you eat a lot of these foods, your liver produces more cholesterol than the body needs — and that can lead to serious problems.
“When there is too much cholesterol in your blood, plaque builds up along the walls of the arteries. Without intervention, the plaque will continue to build and eventually the pathway through the arteries will be narrowed or even completely blocked,” Dr. Hitchcock says. “This disrupts the normal flow of oxygen-rich blood to the heart, and can raise your risk of chest pain, heart attack or stroke.”
Not all cholesterol is bad.
HDL cholesterol, or high-density lipoprotein, is the “good” cholesterol that helps remove the bad or LDL cholesterol and protect the arteries.
LDL cholesterol, which stands for low-density lipoprotein, is considered the “bad” cholesterol that can clog your arteries. Saturated fats like those in beef and full-fat dairy can increase LDL cholesterol and increase heart disease risk.
One in three adults has high levels of LDL cholesterol, according to the Centers for Disease Control and Prevention.
“While some people can control their cholesterol through diet and exercise, others may need medication to get back to healthy levels. That’s where statins come in,” Dr. Hitchcock says.
Statins remain the first line of medication for lowering cholesterol to help reduce the risk of a heart attack or a stroke.
The new guidelines support a more aggressive treatment with statins in certain cases, and recommend new drug options for high-risk patients. For patients who’ve had a heart attack or stroke, or whose LDL cholesterol levels have not been lowered by statins, they recommend use of two new cholesterol-lowering drugs, ezetimibe and PCSK9 inhibitor.
Also recommended are doing a calcium scan of the heart for patients with an ambiguous risk status for heart disease, and starting statin treatment in adults with type 2 diabetes who have LDL-cholesterol levels of 70 or more.
If your physician recommends a statin medication, let him or her know if you have concerns.
“Some people are reluctant to take statins because they are concerned about potential side effects, such as liver problems and muscle aches,” Dr. Hitchcock says.
"These side effects are not common, and if they do occur, we simply discontinue the medication and develop an alternative treatment plan without uncomfortable side effects.”
Unless you've been diagnosed with heart disease already, medication doesn’t have to be your first choice for lowering high cholesterol. Simple lifestyle and nutritional changes are natural ways that you can help bring down your bad cholesterol.
“The primary ways heart attack and stroke risk can be reduced are lifestyle-related,” Dr. Hitchcock says. “This includes managing high blood pressure, tobacco cessation, a healthy diet, plenty of exercise and physical activity.”
If anything, the new statin guidelines will help patients and physicians focus their conversations and actions on disease prevention and management, he adds.
“You can’t rely solely on a pill to do magic,” Dr. Hitchcock says. “But sometimes a pill in combination with lifestyle adjustments can create the best treatment.”