In the past, cardiologists managed patients by cholesterol targets, specifically patients’ low-density lipoproteins (LDL) or bad cholesterol. New guidelines from the American Heart Association and the American College of Cardiology remove cholesterol target levels and replace them with a formula to help physicians calculate the chances of heart attack and stroke in patients.
“The big difference with these guidelines is getting the right people on the right medication at the right dose,” says cardiologist Michael Carlos, M.D. with Robinwood Heart in Hagerstown. The new recommendations focus on risk factors rather than just cholesterol levels.
Under the guidelines, physicians recommend statins for patients with:
- Known atherosclerosis (hardening of the arteries)
- Very high LDL levels (190 mg/dL or above)
- Diabetes with an LDL of 70 or above and who are between the ages of 40-75
- A ten-year risk for stroke or heart attack of 7.5 percent or higher and an LDL cholesterol level of 70 to 189 mg/dL, but with no history of cardiovascular disease
“We’ve always looked at patients’ LDL levels in combination with other risk factors such as family history of stroke or heart disease and smoking,” says Dr. Carlos. “The guidelines give cardiologists a new tool on how to decide who should begin statin therapy.” The guidelines, according to Dr. Carlos, will capture a group of people who were at a substantial risk for heart attack or stroke.
The recommendations also de-emphasize the use of non-statin cholesterol drugs for patients with high LDL levels. Non-statins are useful for patients who cannot tolerate higher doses of statins, however the guideline authors did not find enough evidence to recommend their routine use as a second or third drug in some patients’ medication regimes.
A few caveats come with the new guidelines according to Dr. Carlos.
- Physicians are encouraged to no longer manage to LDL target levels so patients might relax too much, forgetting they are at an increased risk.
- Despite taking cholesterol-lowering medications, patients must still watch their diet, engage in physical activity and stop smoking.
“I’m in favor of getting the right people on a statin at the right dose,” says Dr. Carlos. But statins do come with side effects like muscle pain and muscle damage. In the end, it will be up to patients and their doctors to decide whether they feel there’s enough risk to warrant taking a statin.
By: Anne Gill