New guidelines may increase the number of people on statins
The guidelines focus on risk factors rather than your cholesterol level
One doctor says she believes the new guidelines simplify things
It’s a big change as far as treatment of high cholesterol, but how new treatment guidelines might affect you can be a bit murky.
You may already know you have high cholesterol or that you may be at risk for it. But do you need a cholesterol-lowering statin drug, or can you manage your cholesterol simply by making a few lifestyle changes?
The guidelines, released Tuesday by the American Heart Association and the American College of Cardiology, suggest using specific risk factors to determine who should be prescribed statins, rather than a cholesterol number.
Here are four questions to help determine your risk:
1. Do you have heart disease?
High cholesterol is one of the major controllable risk factors for coronary heart disease and heart attacks, according to the AHA. If you already have heart disease, your cholesterol needs to be managed with medication.
The AHA says this would also include people with a history of heart attack or stroke. Dr. Gina Lundberg of Emory University, who specializes in cardiology and internal medicine, said it would include even a transient ischemic attack, or “ministroke.”
2. Do you have Type 1 or Type 2 diabetes?
Diabetes can greatly increase your risk for a heart attack or stroke, the AHA says. Patients with diabetes often have unhealthy levels of cholesterol. This would include high LDL, or “bad,” cholesterol; a low HDL, or “good,” cholesterol; and high triglycerides – the main form in which fats exist in the body. This condition is called diabetic dyslipidemia.
Adults with diabetes are two to four times more likely to have heart disease or stroke than adults without diabetes, the association says.
Heart disease is the No. 1 killer of all diabetics, Lundberg said.
“It’s not so much that diabetes causes high cholesterol, although we see them hand-in-hand in many patients,” she said. But if someone is diabetic and already at risk, “you want to be more aggressive in reducing their overall risk of things that may lead to a heart attack.”
3. Do you have a bad cholesterol level of more than 190?
An LDL level of 160 is high, but 190 is considered very high. For someone taking a statin, the risk for a heart attack or stroke drops by about 20% for each 39-point reduction in bad cholesterol. Under the new guidelines, anyone 21 or older with an LDL level of 190 or higher should take a statin drug.
That one risk factor means you should be put on a statin, Lundberg said.
As far as reduction, “there’s no number that’s your goal.” She said one of her patients has an LDL of 64, which is low, but under the new guidelines, she should switch him from his moderate-dose statin to a higher-dose one.
“The guidelines are more aggressive than we’ve been (in the past),” she said.
4. Is your 10-year risk of a heart attack greater than 7.5%?
The new guidelines say that those without heart disease, but who have a 7.5% higher risk for a heart attack or stroke, should be on statins. That’s about 33 million Americans. It’s a change from the previous 2002 guidelines, which recommended statins for those whose 10-year risk level exceeded 20%.
Examples of groups who would exceed the threshold, according to the AHA, would be white women older than 60 who smoke and have high blood pressure, or African-American men older than 50 with high blood pressure.
To figure out whether you’re in this category, you should talk to your doctor. Online tools are available, but some are meant for doctors, not patients. The AHA does have a heart attack risk assessment tool on its website that can help you determine whether you are at high risk.
Under the new guidelines, anyone who answers yes to one of those four questions should be taking a statin.
Lundberg predicts there will be very few people coming off statins under the new guidelines and many more going on them.
Referring to the man with the LDL level of 64, she said she told him, “You should have come in yesterday, because I would have told you your cholesterol is great.” But under the new guidelines, he should be switched to a stronger drug.
“I think it simplifies things,” she said. A cholesterol goal is now no longer a number: “Your goal is to reduce your cholesterol as much as we can.”
“I’ve been trying to convince patients for years they need to go on statins because they’re higher risk than they think,” Lundberg said. She hopes attention focusing on the new guidelines will help persuade those patients to give statins a try.
“We really believe that’s how we save strokes and heart attacks (from occurring) and save lives in the end,” she said.