Newswise – A working group composed of two Johns Hopkins Medicine physicians and their American Heart Association colleagues has published cholesterol as a way to minimize risk for heart attack, stroke and death.

The new recommendations, released at the 2018 American Heart Association Scientific Sessions on Nov. 10 in Chicago, advocate for more aggressive treatment with statin therapy in specific instances, while encouraging a more personalized approach to address a heart-healthy lifestyle and better collaboration decision-making between clinicians and their patients. The guidelines incorporate new research findings since the last guidelines were released in 2013.

"These new guidelines do not cover the shortcomings of the 2013 guidelines," says Roger Blumenthal, MD, the Kenneth Jay Pollin Professor in Cardiology at the Johns Hopkins University School of Medicine and director of the Ciccarone Center for the Prevention of Cardiovascular Disease. "There is a greater emphasis on lifestyle, risk assessment improvements for those at high risk for having a future life-threatening cardiovascular event."

"Cholesterol-known as low-density lipoprotein (LDL) cholesterol-to levels less than 70 milligrams per decilitre in high risk patients is best for reducing heart disease complications and risk of dying , At LDL cholesterol level more than 160 is considered very high. A simple blood draw during a visit to the doctor and analysis can determine cholesterol levels.

High cholesterol is one of several controllable risk factors that can increase a person's chance of heart disease. The factors include being overweight, smoking, diabetes, high blood pressure, not getting enough exercise and more. Clinical use of high-cholesterol, giving an estimated risk of having a major cardiovascular (heart or vascular) event in the next 10 days years. High risk is classified as a 20 percent chance of having a heart attack or stroke in the next decade. Intermediate risk is a 7.5-19.9 percent chance over the next decade.

LDL cholesterol levels, genetics plays a role too much. If a parent or sibling has high cholesterol or heart disease, the patient should be more concerned about these conditions. Cholesterol levels increase as a person gets older.

The authors of the guidelines have condensed the recommendations into 10 key messages aimed at clinicians:

Encourage your patients to have a good and healthy lifestyle. Prevent controllable risk factors such as gain, and help patients quit smoking. Lifestyle change is the primary therapy for people with metabolic syndrome, a cluster of risk factors-high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels linked to obesity-that is associated with increased cardiovascular disease risk. The longer patients stay healthy, the longer they can keep their cholesterol levels under control and minimize the chance of developing high blood pressure or diabetes.

  1. Numbers matter, and lower LDL cholesterol numbers are better. For patients who have already had a heart attack, stroke or other episode of cardiovascular disease, clinicians should prescribe the maximum tolerated statin therapy to decrease the risk of future life-threatening events. (New guidelines now support using the Martin / Hopkins method, developed by Seth Martin, M.D.M.H.S., for calculating cholesterol, especially when triglycerides (blood fats) are elevated or LDL cholesterol is low.
  2. Cholesterol-lowering drug ezetimibe (a statin) to the maximum tolerated dose if cholesterol levels are 70 or more. Revisions to 70 cholesterol levels below 70 in very high risk patients may require PCSK9 inhibitors. (Based partly on research by Seth Martin and Steve Jones, M.D.)
  3. Their LDL cholesterol is more than 190 milligrams per deciliter on two occasions. PCSK9 inhibitor therapy if LDL cholesterol levels are still 100 or greater. Discuss lifestyle changes at every doctor's visit.
  4. Who have LDL cholesterol levels of 70 or more. However, Johns Hopkins physicians feel that some patients can not work harder on lifestyle for six months before going on lifelong statin treatment. 35 percent of people with type 2 diabetes would like to have no calcium buildup in their coronary arteries. A coronary artery calcium scan could help determine if statins are necessary for those with diabetes. (Based on work by Michael Blaha, M.D., M.P.H. See number 9 on this list)
  5. The decision-making process, since risk factors alone do not require statin. If the person has a risk factor, he or she may be having a traumatic illness. Clinicians should also keep in mind that people with autoimmune or inflammatory condition such as psoriasis, HIV, rheumatoid arthritis or lupus are at higher risk of heart disease and need to work harder at lifestyle improvements. If their cholesterol numbers remain elevated, they should discuss statin therapy with their clinician. (Based on work by Seamus Whelton, M.D., M.P.H.)
  6. A 30-percent cholesterol reduction, or a 50 percent reduction in high-risk patients, is at or below the limit of a 10-year cardiovascular disease risk.
  7. Clinicians should therefore keep in mind that there is a certain amount of LDL cholesterol above 160, chronic kidney disease, or a history of coronary disease. Women have particular factors placing them more at risk, such as early menopause, preeclampsia and higher triglyceride levels. (Pamela Ouyang, M.D., and Erin Michos, M.D., M.H.S., have written this on.)
  8. Newly incorporated into the guidelines on the coronary artery calcium scan, which can more or less determine the risk of disease. A 0 score on a coronary artery calcium scan can suggest a person has a low 10 year heart disease risk and would benefit from adding a statin. A coronary artery calcium score higher than 100 means the patient has heart disease, is at risk of a life-threatening event and should probably start taking a statin. A coronary artery calcium scan costs about $ 75- $ 100. (Studies by Michael Blaha.) Having any coronary artery calcium strengthens the case for going on statin therapy.
  9. After taking a patient on a statin, clinicians should aim to recheck their cholesterol levels after a month or two to assess if it's working. The statin should lower cholesterol levels by at least 30 percent after about a month. Continue to measure cholesterol each year.

Also, our goal is to reduce the need for angioplasties and the incidence of peripheral arterial disease, which has traditionally not received much attention from clinicians as life-threatening acute vascular events, "says Chiadi Ndumele, MD, MHS, the Robert E. Meyerhoff Assistant Professor at the Johns Hopkins University School of Medicine. Peripheral arterial disease is narrowing or blocking blood vessels from the heart to the legs. About 8.5 million people in the U.S. have the condition, which can make it painful to walk.

Cardiovascular disease kills one in three Americans, including 836,000 people each year, according to the American Heart Association. So, more than 700,000 Americans have heart attacks each year. The leading cause of death for women in the U. is heart disease, which includes heart attack, heart failure, irregular heartbeat or stroke.


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