New guidelines for cholesterol management require personalized risk assessments

New guidelines for cholesterol management require personalized risk assessments


Leading heart experts have published new guidelines for cholesterol management that invite physicians to adapt treatment to more personalized risk assessments of each patient and recommend the use of two new types of medication for people with the greatest fear of disease. The recommendations build on and respond to criticism of guidelines from 2013 that fundamentally change the way in which care providers determine a patient's risk of heart attack and cardiovascular disease. In that river basin document, the experts told doctors that they should stop trying to lower the cholesterol level of patients to specific targets and instead follow a general matrix that tries to predict their future risk of problems. The new guidelines give clinicians a better understanding of how to do this through treatment categories that vary based on cholesterol scores and, if necessary, other tests. The 121-page paper was unveiled on Saturday in the Scientific Sessions 2018 of the American Heart Association in Chicago and published in the Journal of the American College of Cardiology and Circulation magazine of the Heart Association. "We essentially endorse the scope of the risk discussion," said Neil J. Stone, vice chairman of the committee who wrote the guidelines and a professor of cardiology at the Feinberg School of Medicine at Northwestern University. For example, in the guidelines, a & # 39; high intensity & # 39; statin therapy recommended for people younger than 75 years of age who are determined to have atherosclerotic cardiovascular disease, with the aim of low-density lipoproteins (LDL) or "bad". reduce cholesterol by 50 percent. In people aged 40 to 75 years with diabetes, statin treatment with moderate intensity is indicated regardless of the 10-year risk of the patient for disease, according to a different recommendation. Cardiovascular disease is the leading killer of Americans. Almost a third of all American adults have a high LDL level, a major cause of fatty deposits in arteries leading to heart attacks, strokes and other cardiovascular problems. The new recommendations confirm the guiding principles of heart health that "lower is better" when it comes to LDLs, and that people must first try to achieve that by leading a healthy lifestyle from childhood. That includes diet and exercise, controlling blood pressure and avoiding smoking, in addition to other measures. When those steps are not enough, the guidelines again endorse statins as the cornerstone of preventive treatment for people at risk of disease. Approximately 43 million people in the United States take statins to lower their LDL values. The medicines are credited with reducing the risk of heart attacks and strokes. Two medicines have been developed since the last guidelines were issued in 2013 and the panel approved the use in cases where statins are not sufficient. For people who have had a heart attack or have a large number of high-risk conditions, experts suggest adding ezetemibe. The drug, which is marketed as Zetia but also available in generic form, reduces the amount of cholesterol that is absorbed in the small intestine. In some cases, experts also recommend the use of PCSK9 inhibitors, powerful drugs approved by the US Food and Drug Administration in 2015 and blocking a substance that hampers the liver's ability to remove LDLs from the blood. The drugs, mainly used to treat a hereditary condition that causes very early heart attacks, are extremely expensive and the panel offered doctors a way to assess their value. The committee estimated that PCSK9 inhibitors cost more than $ 150,000 for each year of life added. Amgen, the pharmaceutical company that makes the PCSK9 inhibitor Repatha, lowered the catalog price to $ 5850 per year in October to make it more affordable, according to a spokeswoman. When doctors have difficulty deciding how to treat patients, the committee suggests that coronary heartbeat tests can help determine how much plaque has built up on the walls of certain blood vessels. They brought the prospect of starting with cholesterol testing much earlier in life, to identify children who are at risk of developing heart disease. Read more New study expands response time after stroke Low-dose aspirin has no benefit in healthy elderly Heart doctors listen to clues about the future of stethoscopes

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