This advice has further complicated understanding of cholesterol as a risk factor, and confused both patients and health care professionals.
Besides blood cholesterol levels, the new guidelines recommend factors such as age, gender, race, family history, and health-related issues such as smoking, blood pressure, and diabetes be evaluated to determine someone’s overall risk for a heart attack or stroke, and the most effective treatment option.
“In the past, physicians have focused on a patient’s cholesterol levels and then prescribed cholesterol-lowering drugs called statins based on the level of LDL or bad cholesterol,” said Manu Pillai, MD, an interventional cardiologist with Memorial Hermann Southeast Hospital. “This change toward looking at a patient’s overall health and taking inherit risk factors into consideration will produce better outcomes.”
Cholesterol comes either from your body or the food you eat. About 75 percent is made by your liver and other cells, with the rest coming from the animal products you eat, such a meat and eggs.
The two types of lipoproteins that carry cholesterol to and from your body’s cells are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is considered the “bad” cholesterol because it contributes to plaque, a thick, hard deposit that can clog arteries and make them less flexible. HDL is considered the “good” cholesterol because it helps remove LDL cholesterol from the arteries and protects the lining from developing plaque.
Smoking, being overweight, excess alcohol consumption, a diet very high in carbohydrates, and physical inactivity all affect cholesterol levels. Weight loss, dietary changes and physical activity may raise good cholesterol levels; however, the latest medical research 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 having a heart attack or stroke within 10 years. People of any age with a history of a cardiovascular event (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 LDL cholesterol (190 mg/dL or higher). People with Type 1 or Type 2 diabetes who are 40 to 75 years old.“These groups are not cut and dry; other patients may also benefit from statins,” said Pillai. “Physicians should make all medication decisions based on each individual patient’s needs.”
Doctors are also advised to no longer prescribe additional cholesterol-lowering drugs, such as fibrates and niacin, to patients who do not reach targets with statins alone because those drugs have not been shown to reduce heart attack or stroke risk.
Additionally, individuals taking statins no longer need to get LDL cholesterol levels down to a specific target number. While research clearly shows that lowering LDL lowers the risk for heart attack and stroke, there is no evidence to prove that one target number is best.
“While statins lower cholesterol levels, more importantly, they reduce a patient’s overall cardiovascular risk,” said Pillai. “In the bigger picture, I always recommend a healthy lifestyle that includes a good diet and regular exercise along with any statin therapy.”
For information about how the new guidelines affect your health and your medications, call Memorial Hermann Southeast at 281-506-8720.