New Guidelines for Cholesterol Management

High cholesterol is a major risk factor for heart disease and stroke. Abnormal levels of LDL cholesterol or HDL cholesterol have been treated with a low-fat diet, exercise, and medications such as statins.

New guidelines released Tuesday by the American Heart Association and the American College of Cardiology change the standards for who should be taking these cholesterol-lowering drugs. "The new focus is on risk" rather than simply a cholesterol number, says Timothy Henry, MD, director of cardiology at the Cedars-Sinai Heart Institute. "This is a plan for dealing with cardiovascular risk.'' More Americans could benefit from statins According to the new guidelines, cholesterol-lowering statin drugs should now be prescribed to an estimated 33 million Americans without cardiovascular disease who have a 7.5 percent or higher risk for a heart attack or stroke within the next 10 years. These new guidelines could double the number of people on medication to lower their cholesterol, experts say. This is a dramatic change from the 2002 federal cholesterol guideline, which recommended that people should only take a statin if their 10-year risk level exceeded 20 percent. The old guideline only considered a person’s risk for heart disease, leaving out the risk for stroke.

The guideline recommends statin therapy for the following groups:

• People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.
• People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.
• People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
• People with Type 1 or Type 2 diabetes who are 40 to 75 years old.

To calculate 10-year risk, the equation uses race, gender, age, total cholesterol, HDL (good) cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status. The new equations offer greater accuracy in predicting the chances of heart attack or stroke in African-Americans, whose risk levels are higher than whites. But the new risk equations actually benefit everyone. That’s because for the first time, stroke risk has been added to the equation, giving patients a two-in-one assessment of their future cardiovascular health. Living a healthy lifestyle Statins do have side effects, including muscle aches. Living a healthy lifestyle is the first step in lowering your risk of heart attack or stroke, then focusing on the use of statins for moderate to high-risk patients, says Dr. Henry. If your risk is very high, your doctor may not give you time to try lifestyle changes alone but may prescribe medication and encourage you to improve your lifestyle. Diet and exercise are still the best ways to avoid heart disease. It’s just that they aren’t as easy for patients as popping a pill.

Reference: WebMD Health News/ New Cholesterol Drug Guidelines: Q&A/ Kathleen Doheny