New cholesterol guidelines push personalized care
Leading heart experts released new cholesterol management guidelines Saturday that call on doctors to tailor treatment to more personalized risk assessments of each patient and recommend the use of two new kinds of drugs for those at the greatest danger of disease.
The recommendations build on guidelines issued in 2013 that fundamentally altered the way health care providers determine a patient’s risk of heart attack and cardiovascular disease. In that watershed document, the 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 risk of problems.
The new guidelines give clinicians a better idea of how to do that via treatment categories that vary depending on cholesterol scores and, if necessary, other tests. The 121-page document was unveiled Saturday at the American Heart Association’s 2018 Scientific Sessions in Chicago and published in the Journal of the American College of Cardiology and the heart association’s journal, Circulation.
For example, the guidelines recommend “highintensity” 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 aged 40 to 75 with diabetes, “moderateintensity” statin therapy is indicated regardless of the patient’s 10-year risk of disease, according to another recommendation.
Heart disease is the leading killer of Americans. 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 disease.
Two new drugs have been developed since the last guidelines were issued, 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 suggested adding ezetemibe. The drug, which is marketed as Zetia but is available in generic form, decreases the cholesterol absorbed in the small intestine.
In some cases, the experts also recommended 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.