Cholesterol Control Revised in Latest AHA / ACC Guidelines

The American Heart Association and the American College of Cardiology have published their latest 121-page guidelines on the risk badessment and management of high cholesterol levels in individuals exposed to increased risk of heart attack or stroke.

AHA / ACC / AACVPR / AAPA / ABC / ACPM / ADA / AGS / APHA / PHAC / NLA / PCNA Guidelines on the Management of Blood Cholesterol: Report of the Working Group on Clinical Practice Guidelines for the Management of Blood Cholesterol. American College of Cardiology / American Heart Association, "It took 18 months for their recommendations to be prepared.

Formation of cholesterol, fat, artery, vein, heart. Narrowing of a vein for the formation of fat. 3d rendering. Image credit: Naeblys / Shutterstock

The last of such guidelines were published in 2013 by the AHA / ACC and the group said the new recommendations focused on the fact that very low levels of LDL cholesterol are beneficial . LDL cholesterol or "bad" cholesterol contributes to the formation of plaque in the arteries they lead to an increased risk of heart attacks and stroke.

The latest recommendations were published last Saturday (November 10, 2018) at their annual meeting in Chicago. Guidelines Focus on Healthy Eating and Regular Exercises Heart disease, he says, is the leading cause of death in the United States and all measures must be taken to prevent it.

The guidelines indicate that the initial approach to increase cholesterol is a lifestyle change. after which, if they are not controlled, medications are added. Statins are the essential drugs to lower cholesterol and are safe and effective in reducing the risk of heart disease. These guidelines indicate that among people who have had a heart attack or stroke, simple statins are not enough. New cholesterol-lowering drugs need to be added to their daily regimen.

The recommendations suggest statins in the following cases:

• No history of heart attack or stroke and no diabetes, but LDL-C above 70 mg / dL and greater than 7.5. % or more risk over 10 years of calculator
• No history of heart attack or stroke, but diabetes and LDL cholesterol of 70 mg / dL or greater
• History of heart attack or stroke, but not heart failure
• LDL cholesterol ≥ 190 mg / dL or familial hypercholesterolaemia.

According to the new guidelines, statins must be administered in combination with ezetimibe. It works by reducing the absorption of cholesterol in the intestine. For people who have high cholesterol levels or who have a genetic risk of high cholesterol, two new drugs are recommended. These are called proprotein convertase subtilisin / kexin type 9 or PCSK9 inhibitors. ; Two of the available PCSK9 inhibitors are Evolocumab or Repatha from Amgen Inc, Regeneron Pharmaceuticals and Sanofi SA; Alirocumab or Praluate . These were launched in 2015 and cost approximately $ 14,000 per year. The cost of these two agents has limited their use to date, but it is known that they significantly reduce cholesterol levels. To improve their use by doctors and health insurers, their prices have been reduced this year, with Repatha at around $ 5,850 and pruning between $ 4,500 and $ 6,600 a year.

The latest guidelines also include the previously used calculator that can predict the risk of a person's heart disease over 10 years. Smoking, high blood pressure, family history of heart disease, ethnicity and race, premature menopause and the presence of chronic kidney disease are some of the repetitive risk factors. The cholesterol test is recommended from 2 years of age in children with a family history of high cholesterol. Other children who do not have a family history of cholesterol should be tested between 9 and 11 years of age. According to the authors, calcium levels in the coronary arteries (CAC) should be measured in individuals whose risk levels can not be stratified.

The recommendations, supported by 10 other medical societies and organizations, are published in the Journal of the American College of Cardiology. and in Circulation . The team was chaired by Scott M. Grundy of the Southwestern Medical Center at the University of Texas at Dallas, and co-chaired by Neil J. Stone of Northwestern University in Chicago, Illinois.