If you have high cholesterol and you are not taking statins, it is time to make a doctor’s appointment.
Recently, the American College of Cardiology and the American Heart Association presented new guidelines for the prevention of heart attack and stroke that greatly widen the net of people who could benefit from statin therapy. Statins are a class of medication that mainly reduce the levels of cholesterol and in the blood. High cholesterol can lead to hardening of the arteries, chest pain, heart attack and stroke.
The new guidelines – which replace 11-year-old recommendations – were met with immediate skepticism. While previous guidelines supported using statins for secondary prevention of heart disease in men, the new guidelines suggest statins are effective for both primary and secondary prevention in patients of both sexes and all ages, and that they are more effective for those with higher risk factors. The guidelines also discouraged combination therapy because the additional value of agents other than statins have not been established.
I attended the presentation in Dallas and, like many people, I was wary at first. But the science is convincing: The guidelines were generated by a great number of scientists and experts in the field who reviewed the most recent literature and hard outcomes of randomized clinical trials and meta-analyses of random clinical trials.
So, if your doctor uses the new guidelines to give you medication, it is because in the next 10 years your risk of developing a heart attack or stroke is high.
The new guidelines identify four types of people who would best benefit from moderate- or high-intensity statin therapy:
1. People with atherosclerotic cardiovascular disease, or ASCVD.
2. People with LDL or “bad” cholesterol levels over 190 mg/dL.
3. People between the ages of 40 and 75 with either Type 1 or Type 2 diabetes and LDL levels over 70 who don’t have atherosclerotic cardiovascular disease.
4. People between 40 and 75 who have neither ASCVD or diabetes, but who have LDL levels over
70 and have an estimated 10-year risk of ASCVD of 7.5 percent or higher (you can check your risk with a risk calculator atwww.heart.org).
These new guidelines might result in more people being put on statins, but they will also help ensure that those people will benefit from the drug. One of the things that impressed me is that for the first time, African Americans, women and Hispanics are represented in the guidelines.
Also, previous guidelines recommended that doctors focus on bringing “bad” cholesterol numbers down. The new recommendations de-emphasize the numbers and instead suggest treating the individual intensely.
Not only should at-risk people receive statins, they often need to overhaul their diet and exercise routines.
In my practice, I recommend sticking to a Mediterranean diet, rich in fish, nuts, olive oil, vegetables and fruit, which has been shown to reduce cardiovascular events by 70 percent and cancer by 60 percent.
As I have begun using the new guidelines in my practice, I expected some resistance. After all, I was now telling patients they needed medications that were not previously recommended for them. So far, though, the reception has been positive.
So, if you wonder where you stand in terms of your risk of heart disease, heart attack and stroke, go see your doctor.
And if you’re one of my patients, I’ll be expecting your call.
Dr. Eslami is a Cardiologist and Director of Cardiovascular Services at Hoag Hospital Irvine.
