New Cholesterol Guidelines Change The Way Cholesterol Is Treated

The New Cholesterol Guidelines

By Emma Larkin, ARNP

As you may have heard in the news, the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines this week regarding the treatment of high cholesterol.  Many of you are probably wondering, “How does this affect me?”

These new guidelines continue to demonstrate lifestyle changes as the most important part of reducing cardiovascular disease risk.

Unfortunately, for some of us, this is not enough to reduce our risk of cardiovascular disease.  In the past, recommendations for medication to lower cholesterol (mainly “statins” such as simvastatin and atorvastatin etc.) were indicated based on your cholesterol numbers, rather than on your total picture of health.

However, with new cholesterol guidelines, there is more of a focus on other risk factors for cardiovascular disease.   Risk factors such as gender, age, race, total cholesterol, HDL (“good”) cholesterol, systolic blood pressure (the top number), current treatment for high blood pressure, diagnosis of diabetes, and current smoking are calculated to give a percentage of risk for a cardiovascular event within the next 10 years.

Using the old cholesterol guidelines if you had no major risk factors such as diabetes, or established coronary heart disease, and your calculated risk of a cardiac event in the next 10 years was greater than 20% and treatment with a cholesterol lowering agent, a “statin” would be recommended.

In the new cholesterol guidelines, treatment with a “statin” is indicated if your risk calculation is greater than 7.5%.   If you already have atherosclerotic heart disease, you are likely on statin therapy regardless of your risk percentage.  Additionally the new guidelines indicate that if your LDL is greater than 190, you should also be on a statin, regardless of your risk percentage.  The dose of your statin medication will also be based on your personal health risks, instead of being adjusted based solely on your cholesterol numbers.

What does this mean? Overall it is likely that more people will receive recommendations for statin therapy.  However, these new guidelines offer holistic treatment for patients, rather than being treated based on laboratory numbers alone. Even better news is that the calculation and threshold that they are recommending is the same calculation we have been using for years at Sound Health Physicians.  We have always felt that 20% risk factor was too high, and treated patients with a risk factor of 10% or greater.  Additionally, our risk scores are even more complete as they also take into account your carotid artery thickness from the carotid ultrasound that we perform yearly!

The AHA and AAAC do recommend a recalculation of risk factors every 4-6 years.  However, as part of Sound Health Physicians members enhanced physical exam (EPE), this is done yearly INCLUDING carotid artery thickness measurements.  The addition of the carotid artery study increases the sensitivity of determining 10-year heart disease risk.