Cholesterol guidelines recommend changes in assessment and treatment

Cholesterol. It’s that buzz word we hear about from our doctors that can have a major role in our overall health.

You probably have the basics. LDL cholesterol, or low-density lipoprotein cholesterol, is the “bad” variety that can lead to heart disease – the No. 1 cause of death in the United States. More than one third of Americans have high cholesterol.

The American College of Cardiology (ACC) and American Heart Association (AHA) Task Force on Clinical Practice Guidelines published its most recent guidelines for cholesterol management in 2018 but continue to update the guidance to lean into more personalized prevention efforts. As in previous guidelines, the recommendations emphasize lifestyle improvements to lower LDL — with one change on the emphasis of a personalized risk assessment. This includes recommendations for different population segments.

Figuring out your risk is something you and your doctor should do together. They urge doctors and patients to discuss lifestyle factors, family history and ethnicity, as well as medical conditions such as high blood pressure, diabetes, elevated cholesterol and chronic kidney disease, in order to create a personalized plan for cholesterol management.

Whether you are 60 with a history of heart disease, or 25 and looking to understand any potential risks, these guidelines offer specific recommendations:

For people under age 40

Even children can have high cholesterol. More than 20% of those 6 to 19 have at least one abnormal cholesterol level. An early assessment of lifetime risk helps guide discussions with your doctor, who will likely stress “intensive lifestyle efforts.” Risk factors should be assessed every four to six years after age 20. 

For people 40 to 75

At this age, the guidelines state you are a “potential candidate” to take statins, a common medication for high cholesterol, depending on risk factors. The guidelines call for a discussion that considers risk factors, potential advantages and disadvantages of treatment, lifestyle and patient preferences for an individualized treatment decision. Those who don’t need treatment should continue to be evaluated every four to six years. 

If you have high LDL cholesterol combined with risk factors such as diabetes or a history of heart disease, the guidelines offer specific treatment recommendations. This includes a potential change in treatment – the addition of newer drugs – for those at highest risk.

Consider discussing your risk factors and, if needed, a treatment plan, with your doctor. It’s never too late – or too early – to embrace a heart-healthy lifestyle, lowering cholesterol along with your risk of heart disease.

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