Guidelines change on ‘bad cholesterol
Major changes are coming to how doctors recommend Americans think about their cholesterol levels, courtesy of a change to clinical guidelines issued jointly last month by the American Heart Association and the American College of Cardiology.
Among the major changes to the guidelines are new recommendations for earlier cholesterol screening and more aggressive targets for reduction of LDL-C, or “bad cholesterol.”
“The idea of screening at a younger age is one of the main components of the new guidelines,” said Dr. Avinash Linganna, cardiologist at Butler Memorial Hospital. “It's not only what your cholesterol is, but it's the duration that your cholesterol is elevated, which is a significant risk factor for the development of atherosclerosis. So earlier screening is recommended.”
A major addition to the new guidelines is the “PREVENT-ASCVD” calculator, which can predict the risk of cardiovascular disease over a 10- to 30-year period for adults between the ages of 30 and 79.
“Young adults in their 30s should start thinking about addressing their cholesterol,” said Dr. Akshay Khandelwal, interventional cardiologist at Allegheny Health Network. “In fact, kids as young as 9 to 11 years should be checked at least once, just to make sure that they don't have a genetic cause of high cholesterol.”
The AHA and ACC have also added specific reduction targets for LDL-C. The guidelines recommend most adults keep their levels of bad cholesterol under 100 milligrams per deciliter, although those at higher risk of cardiovascular disease are should aim for a maximum of 70 or sometimes even 55 milligrams.
“This is going to potentially impact treatment options, or at least diet and exercise recommendations for more people,” Khandelwal said.
According to Linganna, these targets were removed in previous guideline changes in favor of percentage-based reductions, but the change has now been reversed.
“In the last guidelines, they were just recommending percentages of reductions of your LDL cholesterol but now they're returning to the old system of specific LDL targets,” Linganna said.
For those who feel they need to reduce their cholesterol in a hurry, Linganna recommends making lifestyle changes, especially by switching to a low-cholesterol diet.
“The first line of treatment or therapy would be lifestyle modification,” Linganna said. “You would want to limit saturated fats. You would want to try to replace, like red meat with more vegetables, fruits, whole grain and legumes. The best dietary patterns that we've studied are the DASH diet or the Mediterranean diet.”
Regardless of age, individuals can have their cholesterol levels checked through a blood test and an examination by a primary care physician.
“You'll need to get blood tests to check your cholesterol and you should also have an initial assessment by your primary care physician, who can review your risk factors and determine what additional steps might be needed to mitigate or address the risk factors,” Khandewal said. “And then in some very specialized cases with multiple risk factors, it might be appropriate to refer to cardiology as well.”
