Eleven major medical organizations have issued new guidelines for managing cholesterol and screening for heart disease at an earlier age than previously recommended.
Experts say the update has caught up with the science of how best to prevent and treat cardiovascular disease, which causes about one-third of U.S. deaths
“We need to do more to prevent cardiovascular disease because it remains the number one killer of men and women,” said cardiologist Nathaniel Leibovitz, MD, of Hackensack University Medical Center. “These guidelines should have a big impact.”
Here’s a detailed explanation of these changes and why you may want to bring them up at your next doctor’s appointment.
Early intervention for high cholesterol
One of the biggest changes recommended by the American Heart Association, American College of Cardiology and other professional groups is to start treating high cholesterol as early as age 30. Elevated levels of LDL cholesterol, commonly known as “bad” cholesterol, are a major risk factor for heart disease, and the longer people live, the more damage they cause.
“We now understand that heart disease begins decades before the first symptoms appear,” said Michael Shapiro, a professor of cardiology at Wake Forest University and a member of the committee that developed the guidelines. “Cholesterol exposure accumulates over time, so the earlier the risk is identified and managed, the greater the lifelong benefits.”
The guidelines still recommend controlling cholesterol with exercise and a heart-healthy diet, but there are a growing number of options for people with stubbornly high LDL levels—from statins, a common drug that blocks the enzyme the liver needs to make cholesterol, to newer drugs like Ezetimibe, which prevents cholesterol from being absorbed.
The average LDL level in the United States is about 110, although everyone should keep their LDL below 100. According to the new guidelines, “lower is better,” Dr. Lebowitz said. Dr. Leibovitz said this may seem intuitive, but there had been concerns that low LDL levels could be harmful to the brain.
Recent research suggests otherwise: “Very low LDL does not cause dementia or any other neurological problems. However, it does not cause cardiovascular disease,” he told us.
lipoprotein(a) screening
Recommend now everyone Have lipoprotein(a) or Lp(a) levels tested at least once in adulthood. Lp(a) is a particle that carries cholesterol, and the levels you carry are highly dependent on your genetics and remain largely stable throughout your life.
It is estimated that 20% to 30% of people are born with high Lp(a) levels, with the proportion even higher among African Americans at 30% to 50%. Screening is already part of standard practice in Europe and Canada, and many experts believe it’s time for the U.S. to catch up.
Lp(a) screening is not part of a typical lipid panel but can be measured with a simple blood test. If you haven’t been tested yet, Dr. Lebowitz recommends asking your health care provider. If you are one of the 1 in 5 people with high Lp(a), you should urge your parents, siblings and children to also get tested.
“This is a huge change,” Dr. Leibovitz said. “We will identify many people at risk and hopefully save millions of lives.”
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