New cholesterol guidelines offer a different approach

The new cholesterol guidelines recommend a more personalized approach to risk assessments, a return to LDL target levels, and new treatment options for those most at risk for cardiovascular disease. The guidelines were announced Saturday at the annual scientific conference of the American Heart Association.

The recommendations, prepared by the American Heart Association and the American College of Cardiology, also addressed the benefit of using coronary artery calcium scores for certain patients and patients. widen the age range for treatment.

"The treatment of high cholesterol is not the same solution, and this directive clearly establishes the importance of personalized care," said Dr. Michael Valentine, president of the American College of Cardiology in a press release.

"In the past five years, we have learned even more about new treatment options and the patients who could benefit," he said. "By providing a roadmap for treating clinicians, we are giving them the tools they need to help their patients understand and manage their risks and live longer and healthier lives.

Criticism of previous directives

The new recommendations address many of the concerns raised in the last update of the guidelines five years ago.

The 2013 guidelines were inconvenient for a number of reasons, says Dr. Steven Nissen, president of Cleveland Clinic's Department of Cardiovascular Medicine: "The previous guidelines used a risk calculator that left out crucial elements such as family history. ; they did not address the issue of people over 75 or under 40; they overcame the risks that many patients were facing lowering the threshold required to justify statin therapy; and they eliminated the use of target levels of LDL (bad cholesterol), which allowed patients to set meaningful goals.

People with LDL levels less than or equal to 100, "tend to have lower rates of heart disease and stroke, which supports the philosophy" lower is better, "according to a statement medical organizations about the new guidelines.

A level above 160 is considered "very high," according to a statement from Johns Hopkins Medicine, which also describes the new guidelines. For high-risk patients, it is recommended to reduce "bad" cholesterol to a level below 70.

If statin therapy does not adequately lower LDL levels, the new guidelines suggest adding, in patients who have had a previous heart attack or stroke, other medications – the ezetimibe, available in generic – at the therapeutic regimen. If this combination does not work sufficiently for patients at very high risk, a PCSK9 inhibitor may be added.

The new approach encourages increased collaboration between physicians and their patients. Doctors are encouraged to discuss a wide 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 renal failure.

Impact of high cholesterol on all age groups

Physicians are also asked to look at the life span of patients and the high level of cholesterol. Children from particularly at-risk families can be tested as early as 2 years of age. For most children, however, it is recommended to do an initial test between 9 and 11 years, and then a follow-up test between 17 and 21.

And just as the cholesterol level among the youngest should not be ignored, so are the over 75s, according to the new recommendations.

"They now recognize that it might be appropriate to treat the elderly," said Nissen, who had strongly criticized the latest set of guidelines. "Today's 75-year-old can live a long time."

All of these developments are good signs, "a step forward," said Nissen. "It took five years to resolve the issues raised by the latest set of guidelines, but I'm glad they were resolved."

Nissen only criticized 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 is not clear. This score shows an accumulation of plaque in the arteries and is determined by a scanner, which can cost between $ 800 and $ 1,000, he said.

"You irradiate someone to decide to use a drug that costs only $ 3 a month and you spend a lot of money doing it," he said. "I do not think it's safe."

But aside from that, Nissen is thrilled. "The overview is that it is a set of reasonable guidelines," he said.

Heart disease is the leading cause of death in the United States, according to the US Center for Disease Control and Prevention. Cardiovascular diseases, which include heart attack and stroke-related conditions, account for more than 836,000 deaths annually, according to the American Heart Association and the American Stroke Association.

"Having high cholesterol at any age greatly increases that risk," said Dr. Ivor Benjamin, president of the American Heart Association, in a statement. "That's why it's so important that, even at a young age, people follow a heart-healthy lifestyle and understand and maintain a healthy cholesterol level."