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Experts in the United States have issued an update to their official guidance on how to manage cholesterol and prevent dyslipidemia, a condition where various lipids and lipoproteins build up in the blood to abnormal levels. This update marks a significant overhaul of the former 2018 guidelines, emphasizing taking action earlier to address blood fats that can harm people's health, particularly as approximately one in four adults in the US has high LDL cholesterol, often referred to as 'bad' cholesterol.
Over time, the accumulation of LDL cholesterol in arteries increases the risk of heart attack and stroke. However, 'bad' cholesterol is not the only concern; dyslipidemia can lead to atherosclerotic cardiovascular disease (ASCVD), the world's leading cause of death and morbidity.
Cardiologist Roger Blumenthal from the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, who chaired the guideline writing committee, stated that 'We know 80 percent or more of cardiovascular disease is preventable and elevated LDL cholesterol, sometimes referred to as 'bad' cholesterol, is a major part of that risk.' He added, 'While we want to try to optimize healthy lifestyle habits as the first step to lower cholesterol, we realize that if lipid numbers aren't within the desirable range after a period of lifestyle optimization, we should consider adding lipid-lowering medication earlier than we would have considered 10 years ago.'
The new guidelines, written for doctors and clinicians, primarily focus on initiating treatment for dyslipidemia earlier to reduce the lifelong risk associated with prolonged exposure to atherogenic lipoproteins. According to Blumenthal, 'Lower LDL cholesterol for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk.'
In line with this proactive approach, the guidelines recommend that cholesterol screening should begin for children aged 9–11 years if they haven't been screened previously. Screening can commence as early as two years of age if there is a family history of serious cardiovascular or cholesterol-related disease.
Another significant change is the advice for doctors to utilize a new disease-risk calculator, called PREVENT, to estimate 10-year and 30-year cardiovascular disease risk in patients aged 30 to 79. Blumenthal explained, 'With this new assessment tool, we can better estimate cardiovascular risk using health information already obtained during an annual physical – cholesterol, blood pressure readings, and other personal information such as age and health habits – and then further personalize the risk score for each individual by looking at 'risk enhancers', which can help guide the need for lipid-lowering therapy.'
Depending on the calculations from the new equations, doctors can consider LDL-lowering therapies – including lifestyle interventions and LDL-lowering drugs like statins – if patients are deemed at borderline risk (3–5 percent chance) of developing ASCVD in 10 years, and ought to consider it in intermediate risk cases (5–10 percent risk).
The new guidelines also reintroduce specific goal levels for LDLs to guide lipid-lowering therapy. Researchers suggest that LDL-C goals should be less than 100 mg/dL for those at borderline or intermediate risk, and less than 70 mg/dL for those at high risk. For patients with ASCVD deemed very high risk, the target is less than 55 mg/dL.
Cardiologist Pamela B. Morris from the Medical University of South Carolina stated, 'In general, lower LDL is better, especially for people at increased risk for a heart attack or stroke.' She added that 'Clinical trials have clearly demonstrated significant benefits for reduction in cardiovascular events when LDL-C levels are even lower than recommended in previous guidelines.'
While statins remain the primary medications for lowering LDL levels, the guidelines also incorporate other drugs, including ezetimibe, bempedoic acid, PCSK9 inhibitors, and inclisiran. For patients, the updated advice emphasizes eating healthy foods, understanding that lifestyle changes can lower cholesterol, and taking early action through regular checkups, among other suggestions.
In instances where 'bad' cholesterol levels trend unfavorably despite best intentions, doctors can provide assistance – and with these new guidelines, that could mean altering treatment approaches sooner rather than later. Source: ScienceAlert