New Cholesterol Management Guidelines: A more personalized approach to risk assessment and treatment

By admin
May 18, 2019

Late last year, the American Heart Association and the American College of Cardiology released new cholesterol guidelines that include recommendations for more personalized risk assessments and new cholesterol-lowering drug options for people at the highest risk for cardiovascular disease.

According to AHA President Ivor Benjamin, M.D., the updated guidelines reinforce the importance of healthy living, lifestyle modification and prevention. They build on the 2013 cholesterol recommendations to focus on identifying and addressing lifetime risks for cardiovascular disease.

About one in three adults in the United States have high levels of LDL cholesterol, which contributes to fatty plaque buildups and narrowing of the arteries. High cholesterol treatment is not a one-size-fits-all proposition, and this guideline strongly establishes the importance of personalized care. By providing a treatment roadmap for clinicians, it gives them the tools to help their patients understand and manage their risk. The updated guidelines put a larger emphasis on lifestyle modification and shared decision-making.

The 2013 guideline introduced a major shift in how clinicians treat cholesterol, basing treatment on level of risk for cardiovascular disease rather than solely on cholesterol level. The updated guidelines continue to base treatment on risk, but also recommend non-statin therapy based on cholesterol level in patients at very high risk. The risk calculator introduced in the 2013 guidelines remains a key tool that the new guideline highlights to help health care professionals identify patients’ 10-year risk for CVD.

Using population-based formulas, the guidelines recommend that physicians examine “risk-enhancing factors” and discuss them with patients to personalize their risk assessment, while also continuing to use traditional risk factors such as smoking, hypertension and high blood sugar to address under- or overestimated risk in some individuals. Risk-enhancing factors include a positive family history; specific racial/ethnic backgrounds; and certain health conditions such as metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or pre-eclampsia, and high lipid biomarkers.

Considering the cumulative effect of high cholesterol during an entire lifespan, the new guidelines noted that identifying and treating it early can help reduce the lifetime risk for cardiovascular disease. And, it offers more specific recommendations for certain age and ethnic groups, as well as for people with diabetes – all important factors that should be considered during any comprehensive and individualized physician-patient discussion on this topic.

Well-Being reached out to J. Kevin Bridges, M.D., of Merit Health Medical Group, who specializes in Internal Medicine and also holds special certification as a Lipidologist, about the new cholesterol guidelines.

“Mississippi is ranked 1st in heart disease related deaths in the US, based on the latest data from the CDC as of 2017,” notes Dr. Bridges. “I do not know any of my fellow Mississippians who want this metric to be the one we are known to be 1st in. If we are to fall in the rankings, it is imperative that physicians and patients alike, focus on the new guidelines to better establish the risk for each patient and work together to develop an evidenced based treatment plan to reduce that patient’s individual risk of heart disease related death. The big take away from the guidelines is that every patient, regardless of risk, should focus on improving lifestyle choices whether medication is indicated or not.”

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