American Heart Association Issues Updated Cholesterol Guidlines

CHICAGO, IL -- The American Heart Association met at the 2018 Scientific Sessions conference in Chicago to present new guidelines for more personalized risk assessments and new cholesterol-lowering drug options for people at the highest risk for cardiovascular disease according to a press release by the American Heart Association.

“The updated guidelines reinforce the importance of healthy living, lifestyle modification and prevention. They build on the major shift we made in our 2013 cholesterol recommendations to focus on identifying and addressing lifetime risks for cardiovascular disease,” said Ivor Benjamin, M.D., FAHA, president of the American Heart Association. “Having high cholesterol at any age increases that risk significantly. That’s why it’s so important that even at a young age, people follow a heart-heathy lifestyle and understand and maintain healthy cholesterol levels.”

The guidelines were simultaneously published in the American Heart Association journal, Circulation and the Journal of the American College of Cardiology.

One and every three Americans have bad cholesterol, which is having high levels of low-density lipoprotein cholesterol. About 94.6 million, or 39.7 percent, of American adults have total cholesterol of 200 mg/dL or higher, while research shows that people with LDL-C levels of 100 mg/dL or lower tend to have lower rates of heart disease and stroke, supporting a “lower is better” philosophy.

For people who have already had a heart attack or stroke and are at highest risk for another and whose LDL-C levels are not adequately lowered by statin therapy, the guidelines now recommend the select use of other cholesterol-lowing drugs that can be added to a statin regimen, such as a PCSK9 inhibitors. In primary and secondary prevention, when high cholesterol can’t be controlled by diet or exercise, the first line of treatment is typically statins, mostly available in generic forms and long-proven to safely and effectively lower LDL-C levels and CVD risk.

“There have been concerns over the cost of PCSK9 inhibitors and some insurance companies have been slow to cover them, so it’s important to note that the economic value of these new medications may be substantial only for a very specific group of people for whom other treatments haven’t worked,” Benjamin said. “The Association is bringing together stakeholders to discuss financial barriers to the care of heart disease and stroke. We have been heartened that drug makers have recently agreed to reduce the prices of PSCK9 inhibitors and are making arrangements with payors to ease the financial burden for patients who could benefit from the additional medication options.”

Another new aspect of the guidelines is the recommendation of coronary artery calcium (CAC) measurements for people in some risk categories, when their risk level isn’t clear and treatment decisions are less certain. A CAC score of zero typically indicates a low risk for CVD and could mean those people can forego or at least delay cholesterol-lowering therapy as long as they are non-smokers or don’t have other high-risk behaviors or characteristics

Recognizing the cumulative effect of high cholesterol over the full lifespan, identifying and treating it early can help reduce the lifetime risk for CVD. This is why it is also important for parents to start informing their children, and showing them good healthy habits.