HealthNew cholesterol guidelines recommend a more personalized approach in risk assessments, a returned focus on LDL target levels and new drug options for those at highest risk for cardiovascular disease. The guidelines were announced Saturday during the American Heart Association’s annual scientific conference.
Criticism of previous guidelines
A level of above 160 is considered “very high,” according to a release from Johns Hopkins Medicine, which a Blog also outlined the new guidelines. For high-risk patients, the recommendation is to lower “bad” cholesterol to levels below 70.
The new approach encourages increased collaboration between doctors and their patients. Doctors are encouraged to discuss a broad range of factors that may increase risks, such as family history and ethnicity, as well as other conditions including metabolic syndrome, premature menopause, and chronic kidney disease.
Doctors are also being urged to look at the lifetime of patients and how high cholesterol takes a toll. Children born to especially high-risk families can be tested when they are as young as 2. For most children, though, the recommendation is to have an initial test between ages 9 and 11, and then a follow-up test between the ages of 17 and 21.
And just as cholesterol levels in younger people shouldn’t be ignored, the same goes for those over 75, the new recommendations say.
“They now acknowledge that it might be appropriate to treat older people,” something they didn’t do in 2013, said Nissen, who was highly critical of the last round of guidelines. “Today’s 75-year-old can live a long time.”
All of these developments are good signs, “a step forward,” Nissen said. “It took five years to fix the problems with the last set of guidelines, but I’m glad they’ve been addressed.”
Nissen offered just one criticism of the new recommendations: the suggestion that coronary artery calcium scores be used to help determine the need for cholesterol-lowering treatments in patients for whom the need isn’t clear. This score shows plaque buildup in arteries and is determined through a CT scan, which can cost between $800 and $1,000, he said.
But other than that issue, Nissen is pleased. “The big picture is this is a reasonable set of guidelines,” he said.
Heart disease is the leading cause of death in the US, according to the US Centers for Disease Control and Prevention. Cardiovascular disease, which includes conditions that cause heart attacks and strokes, account for more than 836,000 deaths a year, according to the American Heart Association and the American Stroke Association.
“Having high cholesterol at any age increases that risk significantly,” Dr. Ivor Benjamin, president of the American Heart Association, said in a written statement. “That’s why it’s so important that even at a young age, people follow a heart-healthy lifestyle and understand and maintain healthy cholesterol levels.”