Individual risk key to cholesterol therapy
Leading heart experts have released new cholesterol-management guidelines that call on doctors to tailor treatment to more personalized risk assessments of each patient.
The recommendations build on guidelines issued in 2013 that fundamentally altered the way health-care providers determined a patient's risk of heart attack and cardiovascular disease. Experts told doctors to stop trying to lower patients' cholesterol numbers to specific targets and instead follow an overall matrix that tries to predict their future risk of problems.
The new guidelines released recently give clinicians a better idea of how to do that via treatment categories that vary depending on cholesterol scores and, if necessary, other tests.
For example, the guidelines recommend "high intensity" therapy with statins for people under the age of 75 who are determined to have atherosclerotic cardiovascular disease, with the goal of reducing their LDL, or "bad," cholesterol by 50 percent.
In people who are 40 to 75 years old with diabetes, "moderate intensity" statin therapy is indicated regardless of the patient's 10-year risk of disease, according to another recommendation. Nearly a third of all U.S. adults have high LDL levels, a major cause of fatty deposits in arteries that lead to heart attacks, strokes and other cardiovascular problems.
The new recommendations reaffirm the guiding principles of heart health that "lower is better" when it comes to LDLs, and that people should try to achieve that first by living a healthy lifestyle, starting in childhood. When those steps aren't sufficient, the guidelines again endorse statins as the cornerstone of preventive treatment for people at risk of heart disease.
Two new drugs have been developed since the last guidelines were issued in 2013, and the panel endorsed their use in cases when statins are not sufficient. For people who have suffered a heart attack or have numerous high-risk conditions, the experts suggest adding ezetimibe. The drug decreases the amount of cholesterol absorbed in the small intestine.
In some cases, the experts also recommend the use of new PCSK9 inhibitors, powerful drugs approved by the Food and Drug Administration in 2015 that block a substance that hinders the liver's ability to remove LDLs from the blood. The drugs, currently used mainly to treat an inherited disorder that causes very early heart attacks, are enormously expensive.