New Cholesterol Guidelines for Heart Health
Monitoring your cholesterol levels can reduce the risk of having a life-threatening cardiovascular event.
High cholesterol puts you at risk for the two leading causes of death in the United States, heart disease and stroke. Nearly one in three American adults have high cholesterol. The new cholesterol guidelines, released by the 2018 American Heart Association in November 2018, advocate for more aggressive treatment with statin therapy (drugs used to lower cholesterol) in specific instances, while encouraging a more personalized approach in treating patients. “These new guidelines suggest a greater emphasis on lifestyle, risk assessment improvements and strong treatment benefits for those at high risk for having a future life-threatening cardiovascular event,” says Dr. Frank Wilklow, a cardiology and interventional cardiology specialist at Crescent City Physicians, Inc., a subsidiary of Touro Infirmary. “In addition, it is recommended that physicians use coronary artery calcium scores as a second-line decision-making tool when determining whether or not a patient should use statins.”
The New Lifespan Approach
Having high cholesterol at any age significantly increases the risk of cardiovascular disease. Because of the potentially dangerous effects of a lifetime exposure to high cholesterol, particularly LDL, doctors are asked to consider selective screenings of children as young as two years old who have a family history of early heart disease or high cholesterol. In children without any known risk factors, doctors can recommend tests for children between the ages of 9 and 11 and again between the ages of 17 and 21.
Because of a lack of sufficient evidence of high cholesterol in young adults, there are no specific recommendations for that age group. However, it is essential that they adhere to a healthy lifestyle, be aware of the risk of high cholesterol levels and get treatment as appropriate at all ages to reduce the lifetime risk of heart disease and stroke.
“All adults aged 20 and older should have their cholesterol levels checked at least once every five years,” Dr. Wilklow says. “If you have elevated cholesterol, you should have it tested more often. Talk with your doctor to find out how often is best for you.”
A healthy diet and regular physical activity are recommended for all age groups. Healthy eating includes avoiding fried foods, processed foods and saturated fats, and incorporating more fruit, vegetables and fish into your diet. The DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets include foods low in total fat, saturated fat and cholesterol.
10-Year Risk Assessment
In the past, the guidelines suggested screening for those with conditions that put them at a higher risk for developing heart disease, such as high blood pressure, diabetes and congenital heart defects. “The new cholesterol guidelines help doctors determine when to screen for cholesterol, when to treat the patient prior to an event and how aggressive that treatment should be,” Dr. Wilklow says.
While there is no target for ideal LDL cholesterol levels in the general population, the guidelines recognize that lower is always better. For patients on the borderline, it is suggested that doctors have an in-depth discussion with their patients to consider the potential benefits of statin drugs, as well considering all of the risk factors. If uncertainty remains about whether to use a statin, doctors can consider delving further with a test called coronary artery calcium, or CAC, screening. A CAC score is calculated based on taking a CT scan of the heart and determining how much calcium plaque is building up in the heart’s arteries.
By calculating the risks, doctors can then give a detailed assessment of a person’s 10-year risk for heart disease and help create a personalized plan. For patients who can’t control their cholesterol with diet and exercise, statin is prescribed. When a patient is considered high risk (those with a coronary heart disease, who have had a stroke or have very high cholesterol caused by genetic conditions), additional drugs called ezetimibe, and PCSK9 inhibitors may be used.
“Once there is an atherosclerotic cardiovascular disease (plaque in the arteries), the used of high-intensity statin therapy or maximally tolerated statin therapy is recommended along with lifestyle modifications,” Dr. Wilklow says. “The goal is to lower LDL cholesterol level by 50 percent or more for patients with a history of prior cardiovascular events such as heart attacks, or of procedures such as stenting.”
Technology Helps Heart Health
When asked to describe the changes he has seen in the past two decades, Dr. Wilklow says that technology is through the roof, from wireless pacemakers to chips installed to monitor arrhythmia. “The Impella pump is a temporary pump that we utilize to put inside a patient’s heart in order to perform complex interventions and avoid bypass surgery,” Dr. Wilklow says. “In some cases, we have used the Impella pump during a massive heart attack. We go in, fix the blockage and then let the heart take over.”
Abbott’s Confirm Rx is an insertable cardiac monitor that is placed under the skin to record heart rhythms. The devices help diagnose the cause of fast or slow heartbeats, palpitations, fainting spells,and unexplained stroke. The monitors are typically synched to a handheld device so that patients can record irregularities and a bedside transmitter that sends data to doctors overnight. They can also add details about what they were doing when those symptoms occurred.
Dr. Frank Wilklow specializes in cardiology and interventional cardiology at Crescent City Physicians, Inc., a subsidiary of Touro Infirmary. After earning his medical degree from Louisiana State University School of Medicine in New Orleans, Dr. Wilklow completed a residency at Charity Hospital in New Orleans. He completed his fellowship in internal medicine at Charity Hospital and a fellowship in cardiology/interventional cardiology at Tulane University. With more than 14 years of experience, Dr. Wilklow continues his practice because he loves the challenge of diagnosing difficult cases and forming longterm patient-doctor relationships.