The American Heart Association and the American College of Cardiology – two of the nation’s leading organizations focused on heart health – recently issued new guidelines to direct how physicians treat cholesterol to reduce the risk of cardiovascular diseases.
The new guidelines – which are the result of a four-year scientific review – are aimed at standardizing care but have overturned longstanding practice and spawned confusion among some physicians and patients.
So we reached out to Jefferson cardiologist Danielle Duffy, MD, who specializes in prevention, to ask about the new guidelines.
Q: How are these new guidelines going to impact your patients?
Dr. Duffy: This is going to be a big change for both patients and providers. We have been very used to trying to achieve a specific LDL-C – or “bad” cholesterol – level and check labs and adjust the medications to achieve that target.
Now, the focus is supposed to be more on whether a patient is on the right medications and not necessarily what levels they achieve on those medications. For me, it will be difficult to move away from checking the cholesterol profile. We often find that patients have fallen off track with diet or medications by checking the labs. I also find that patients are more engaged in their own therapy when they are striving for a goal, whether it’s lowering cholesterol or blood pressure or blood sugar.
Q: How will this change how cardiologists evaluate and treat their patients?
Dr. Duffy: The biggest change is that the new guidelines are not recommending that we treat to a particular cholesterol-level target. For example, the prior guidelines recommended that patients with coronary artery disease receive treatment in order to reach an LDL-cholesterol target of less than 70 mg/dL. The current guidelines focus more on the intensity of the treatment and recommend that for the highest risk patients, the highest doses of statins be used.
Q: What do you recommend for people who want to avoid taking statins? Are there alternatives? What are they?
Dr. Duffy: Adhering to a heart healthy lifestyle is one of the best ways to prevent heart disease. It is critical to quit smoking if you smoke. With regards to the diet, it is important to minimize saturated fats and to choose fresh fruits and vegetables, lean meats and whole grains as part of the diet. Regular exercise is also important – 30 min of aerobic exercise per day with light weights a few days out of the week is ideal. Having a diet high in fiber can help reduce cholesterol.
For people whose cholesterol is still too high and doctors recommend a medication, there are alternatives to statins that should be discussed with your doctor if you are unable to take statins for any reason.
You’ll find more details in the article, “How to Lower Your Cholesterol Levels Without Medication” from an earlier issue of Keep in Touch with Jefferson.
Q: How do high blood pressure, diabetes and cholesterol levels impact cardiovascular health?
Dr. Duffy: Cardiovascular disease (CVD) is caused by numerous factors that affect the lining of the blood vessels and ultimately lead to cholesterol buildup in the arteries. High blood pressure puts extra stress on the vessels, and over time can make them more susceptible to damage. The same is true for diabetes. The higher the cholesterol, the more likely it is to deposit in the arteries. Very high levels can cause plaque buildup even without other risk factors like high blood pressure or diabetes.
Q: Can you distinguish between folks with known heart disease and have had an event (heart attack), and those who have not, but are at risk or diagnosed with early stage heart disease, and what the new guidelines mean for both groups?
Dr. Duffy: The guidelines recommend high intensity statin therapy for those patients less than 75 years old who have had acute coronary syndromes, history of heart attack, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA or peripheral arterial disease presumed to be of atherosclerotic origin.
For those who have mild atherosclerosis detected by other means the guidelines are less clear, although they should certainly receive preventive therapy since they are already showing signs of plaque buildup. For people who don’t fit one of the three groups where statin therapy is recommended (known CVD, LDL >190 or diabetics between the ages of 40 and 75), there is a risk calculator that incorporates factors such as age, gender, ethnicity, smoking status, blood pressure, total cholesterol and HDL-C to help determine if the risk of CVD is great enough to warrant treatment with statin therapy.
To make an appointment with a Jefferson cardiologist, call 1-800-JEFF-NOW (1-800-533-3669) or use our online appointment request form.