Cholesterol: the New Approach to Managing Your Cholesterol Levels

I am 72 years of age and have a family history of heart disease in both of my parents. I have been very concerned about heart health and my cholesterol level. This blog is intended to discuss the new numbers and what you need to know about using medication to lower your cholesterol levels.

More than a quarter of Americans older than 40 are taking a statin, a number that could rise to 46 percent of people aged 40 to 75 under the newest prescription guidelines, especially now that almost all statins are available as inexpensive generics. A recent study showed that prescribing statins under the new guidelines could cut in half the number of people who develop clinical evidence of cardiovascular disease.

Because statins are cheap, as well as effective and safe for most people, doctors often prescribe them for otherwise healthy patients with elevated cholesterol, even if they have no other cardiovascular risk factors. Yet many who could benefit — including people with established heart disease and serious risk factors like smoking, diabetes and high blood pressure — who are not on a statin for reasons that include reluctance to take daily medication, and concern about possible or actual side effects.

While best known for their ability to lower serum cholesterol, statins also reduce artery-damaging inflammation that can result in a life-threatening blood clot. By lowering cholesterol, statins also appear to stabilize plaque, artery deposits that can break loose and cause a heart attack or stroke. And they may cleanse arteries of plaque that has not yet become calcified.
Instead of striving for a target level of, say, under 200 for total cholesterol and under 100 for LDL, the new guidelines, put forth by the American College of Cardiology and American Heart Association, focus on four main groups who could be helped by statins.
1. People who have cardiovascular disease, including those who have had a heart attack, stroke, peripheral artery disease, transient ischemic attack or surgery to open or replace coronary arteries.
2. People with very high levels of LDL cholesterol, 190 milligrams or above.
3. People with an LDL level from 70 to 189 milligrams who also have diabetes, a serious cardiovascular risk.
4. People with an LDL level above 100 who, based on other risks like smoking, being overweight or high blood pressure, face a 7.5 percent or higher risk of having a heart attack within 10 years.
Gone are the recommended LDL(low density lipoprotein)- and non-HDL(high density lipoprogein)–cholesterol targets, specifically those that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL. According to the expert panel, there is simply no evidence from randomized, controlled clinical trials to support treatment to a specific target. As a result, the new guidelines make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of atherosclerotic cardiovascular disease.

Bottom Line: The new guidelines identify four groups of primary- and secondary-prevention patients in whom physicians should focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate dose of statin therapy in order to achieve relative reductions in LDL.

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