Start earlier to lower your cholesterol for a healthy heart

The guidance addresses abnormal levels of one or more types of lipids or lipoproteins in the blood, including cholesterol and triglycerides, which contribute to heart disease and stroke; 1 in 4 adults has high levels of low-density lipoprotein-cholesterol (LDL-C), also known as “bad cholesterol,” a major preventive risk factor.

“Cardiologists think these cholesterol guidelines are a very important deal,” said Dr. Gina Lundberg, a preventive cardiologist at Emory University and president-elect of the Southeast Lipid Association. The focus of the new guidelines is on long-term risk, she explained.

“The longer the arteries are exposed to high cholesterol, the more likely there is to be atherosclerotic [artery plaque] development and then adverse outcomes from it — stroke, a heart attack from artery disease.”

Credit: Emory Healthcare

Credit: Emory Healthcare

Lundberg is also a board member of the National Lipid Association that reviewed the guidelines before it endorsed them with eight other major medical organizations.

“There was a lot of emphasis on evaluating younger, treating younger, and treating more aggressively. The hope is that this will translate into fewer outcomes — less heart disease, less kidney disease, less vascular disease, less diabetes.”

A new risk calculator, for example, was designed for adults starting at age 30 without known atherosclerosis, a buildup of plaque in the arteries that can lead to heart disease. The calculator estimates a 10- and 30-year risk of heart attack or stroke and guides lipid-lowering therapy such as statins medication and newer treatments in addition to lifestyle management, such as healthier diet and exercise.

Previous risk calculators didn’t take into account enough risk factors, and their resulting scores weren’t as accurate as the new calculator’s, Lundberg said.

Highlighting early prevention, the guidelines note that cholesterol can begin affecting long-term heart disease risk in childhood and recommended routine screening for children between ages 9 and 11.

Children with a family history of atherosclerosis should be screened as early as 2 years old, 10 years old and again at 18, Lundberg said, noting that early screening allows for earlier treatment and can reduce the likelihood that children will develop the disease.

Credit: Wellstar Health System

Credit: Wellstar Health System

Frank Corrigan, an interventional cardiologist with Wellstar Health System, said the recommendations are “focused on trying to prevent people from having heart attacks and strokes altogether,” rather than taking a reactive approach used in the past.

He said the guidelines emphasize that elevated lipids over time can be dangerous.

“Atherosclerosis is a process that takes place over years and decades, which eventually results in a heart attack or stroke, and if we can intervene somewhere in the years two decades before that first event, we can prevent it.” .

Corrigan suggested starting with diet and exercise to lower lipid levels and adding medication when needed, especially for younger, otherwise healthy patients. He also pointed out a new recommendation for all adults to have their lipoprotein (a) measured at least once.

“Doing that universally, I think, will allow us to better identify those patients who have future risk.”

Credit: Piedmont

Credit: Piedmont

Dr. Jyoti Sharma, a cardiologist and chief medical officer of Piedmont Atlanta Hospital, said the guidelines reinforce lower LDL goals.

“We’ve gotten more strict, and the goals for LDL reduction are far more aggressive,” she explained. In general, we know that a lower LDL is better, and that is especially true for people who are at increased risk for heart attack or stroke,” Sharma said.

“Based on the new guidelines, we would consider adding a lipid-lowering medication to a patient at much lower thresholds than we would have done 5 or 10 years ago.”

Previous screening tools were also designed primarily for older patients, Sharma said. “Some of these risk calculators were used for patients that were aged 40 and above, but now these guidelines tell us we need to start looking at people’s cardiovascular risk when they hit 30 years old. We want to focus on their cholesterol so we can focus on prevention.”

The vast majority, or about 80% of heart disease cases, are preventable, she shared. “High cholesterol is a major part of that risk, so that’s why we want to start looking at younger folks, even children, so we can intervene if needed.”

The new calculator also allows clinicians to assess a patient’s 10- and 30-year cardiovascular risk.

“It is pretty wild that we’re thinking that far ahead, but that’s good,” Sharma said. She expects to continue talking to her patients about lowering their LDL and hopes the guidelines will support prevention efforts to prevent heart disease.

“I just really want to encourage folks to know their numbers, go get screened and then take next steps to take good care of themselves.”

Roni Robbins has been a journalist for nearly four decades. This is her second stint as a freelance reporter for the AJC. She also freelances for Medscape, where she was an editor. Her writing has appeared in WebMD, HuffPost, Forbes, the New York Daily News, BioPharma Dive, MNN, Adweek, Healthline and others. She’s also the author of the award-winning novel, “Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune.”