Promoting healthy lifestyles and giving statins to those who can most benefit from them is the impetus for new cholesterol guidelines released November 2018 from the American College of Cardiology and the American Heart Association. This is an update from the 2013 guidelines. Risk factors for cardiovascular disease due to high cholesterol has evolved from targeting a specific set of numbers to a more holistic, individualized view of risk factors for each patient from their health care provider.
“A lot of progress has been made in the research regarding cholesterol metabolism and our understanding of its relationship to the risk of cardiovascular disease and stroke,” said neurologist Jin-Moo Lee, M.D., the Norman J. Stupp Professor of Neurology and director of the Cerebrovascular section of the department of Neurology at Washington University School of Medicine in St. Louis. Based on the best available evidence, Lee said there are several different changes.
“There is an emphasis to personalize the recommendations, based on a variety of factors, including levels and certain additional risk factors,” he said. “For those at risk, we want to lower as much as possible, because we know from the available evidence that the lower the cholesterol level is, the better it is in terms of reducing risk.”
Those additional risk factors include existing health issues, genetics and lifestyles.
“One of the major risk factors is diabetes,” Lee said. “If you have diabetes, we know that strict lowering of cholesterol is even more important. In those individuals with diabetes, we start thinking about lowering cholesterol at a younger age than we might have previously. We are looking at lower middle-ages – people aged around 40 or more.”
Other risk factors, Lee said, smoking, high blood pressure, high blood sugar, family history, race and ethnicity. There is a new calculator that considers the many factors that go into making a decision about starting someone on a statin therapy for cholesterol.
“There is a risk calculator that will examine all of these factors to determine what your risk for cardiovascular disease is,” Lee said. “And the variables that go into this calculator are race, cholesterol, LDL, HDL-cholesterol, blood pressure, diabetes and smoking. And so these risk calculators help us determine who would best benefit most from cholesterol lowering.”
Lee said cholesterol and cardiovascular risk should be a discussion between you and your doctor or health care provider, because there are still other factors beyond the calculator that go into it.
“With our accumulated understanding of cholesterol, we have learned that it’s incredibly important in terms of our lifetime risk for cardiovascular disease and stroke, and so understanding what our levels are as well as our risk factors are very important even from a young age,” Lee said. “Because the sooner we get therapy onboard, the more we can prevent future disease.”
