Health Policy & Advocacy
Basic InformationMore InformationLatest News
California Farm Implicated in Outbreak of E. coli Tied to Romaine LettuceFentanyl Now the No. 1 Opioid OD KillerHospitalizations Rising Among the HomelessElectronic Health Records Bogging Docs DownMore Are Seeking Mental Health Care, But Not Always Those Who Need It MostMillions of Americans Still Breathing Secondhand Smoke: ReportNew Approach to Opioid Crisis: Supervised Heroin Injection Programs?Many Americans Unaware of Promise of Targeted, 'Personalized' Medicine: PollAs Gun Violence Grows, U.S. Life Expectancy DropsMost Americans Lie to Their DoctorsOpioid Crisis, Suicides Driving Decline in U.S. Life Expectancy: CDCWant to Learn CPR? Try an Automated KioskHealth Surrogates Often in Dark About Loved One's WishesRestaurant 'Health Grade' Posters Could Mean Safer DiningSmoking Bans Might Help Nonsmokers' Blood PressureWarmer Winters, More Violent Crimes?Are Food Additives Good or Bad? Consumer Views VaryDrug Studies in Children Often Go Unfinished: StudyFDA Moves to Restrict Flavored E-Cig Sales, Ban Menthol CigarettesAgeism Costs Billions in Health Care DollarsAmerica Is Worried About Antibiotic ResistanceRed Cross Issues Urgent Call for Blood Ahead of the HolidaysUnder Pressure, Juul Withdraws Most Flavored E-Cigs From MarketMany Drugstores Won't Dispense Opioid Antidote as RequiredNew Cholesterol Guidelines Focus on Personalized ApproachAHA: Defibrillators Can Help Kids Survive Cardiac Arrest, TooFDA Will Ban Many Flavored E-CigarettesU.S. Smoking Rates Hit Record LowOnly a Quarter of Opioid Painkillers Taken After Most SurgeriesHome Health-Care Tests: Proceed With CautionFDA Takes on Flatulent CowsWhy Bystanders Are Less Likely to Give CPR to WomenCellphone Radiation Tied to Upped Odds for Cancer -- in RatsHealth Tip: FDA Discusses Possible Risks of Bodybuilding ProductsU.S. Hospitals Making Headway Against InfectionsAfter Mass Shootings, Blood Donations Can Go UnusedLead in Hair Dyes Must Go: FDAIn California, Some Doctors Sell 'Medical Exemptions' for Kids' VaccinationsGot Unused Prescription Meds? Saturday Is National Drug Take-Back DayFDA Too Quick to Call BPA Chemical Safe, Health Experts SayIs Crowdfunding Too Often Used for Bogus Treatments?Many Supplements Still Contain Dangerous Stimulants: StudyTapping Into TelehealthMenthol Cig Ban Didn't Spur Black Market Sales: StudyHip-Hop Loaded With Pot, Cigarette ReferencesWhite House Wants Prices in Drug Ads, But Big Pharma Fights BackMany Supplements Contain Unapproved, Dangerous Ingredients: StudyE-Cigs Continue to Spark Debate Over Health Risks/BenefitsClinical Trials Need More VolunteersGetting Your Medical Records Might Not Be Easy
Questions and AnswersVideosLinksBook Reviews
Related Topics

Health Insurance

New Cholesterol Guidelines Focus on Personalized Approach

HealthDay News
by By Dennis Thompson
HealthDay Reporter
Updated: Nov 12th 2018

new article illustration

SATURDAY, Nov. 10, 2018 (HealthDay News) -- A lifelong approach to lowering cholesterol, starting in some kids as young as 2, is the United States' best bet to lower everyone's risk of heart attack and stroke, according to updated guidelines released Saturday by the American Heart Association (AHA).

"Personalized" cholesterol-fighting tactics recommended by the guidelines include:

  • More detailed risk assessments, to help figure out a person's specific risk of heart disease, including the use of CT scans to detect hardened arteries.
  • Harder-hitting cholesterol drugs like ezetimibe or the new, expensive class of drugs called PCSK9 inhibitors should be added on top of statins for high-risk people who are struggling to lower their levels.
  • Initial cholesterol blood tests for kids between the ages of 9 and 11 to gauge their lifetime risk early, including tests for children as young as 2 with a family history of heart disease or high cholesterol.

Nearly one of every three American adults have high levels of "bad" LDL cholesterol, which contributes to fatty plaque buildup and narrowing of the arteries, the AHA said. People with LDL levels of 100 mg/dL or lower tend to have lower rates of heart disease and stroke.

"The science has shown that having high cholesterol at any age increases risk significantly," said AHA President Dr. Ivor Benjamin. "That's why it is so important that even at a young age people are following a heart-healthy lifestyle and understand and maintain healthy cholesterol levels."

Focus on lifestyle first

Starting cholesterol tracking as early as possible is important because many people have no idea about their levels, said Dr. Neil Stone, a professor of cardiology with Northwestern University's Feinberg School of Medicine.

"I run a lipid [cholesterol] clinic, and I constantly see people in their 20s and 30s who've never had a cholesterol test and their LDLs are 200 or higher," said Stone, who co-chaired the guideline writing committee. "We simply didn't know their family histories."

Only healthy lifestyle changes would be recommended in kids and teens with high cholesterol, since there's a lack of evidence regarding the use of cholesterol-lowering drugs that early, the AHA said.

People from age 20 onward should receive regular heart risk assessments, including cholesterol testing, according to the guidelines released at the AHA's annual meeting in Chicago.

One big positive -- people not taking statins don't have to fast before taking their cholesterol blood test, the guidelines say.

"Finally, finally we've embraced the idea that people don't have to be fasting to get their cholesterol checked," said Dr. Martha Gulati, division chief of cardiology for the University of Arizona-Phoenix and editor of for the American College of Cardiology.

"If I have clinic in the afternoon, do you think any of my patients are fasting? Even in the morning clinic, I'm lucky if they didn't eat a couple of donuts before they came," Gulati said.

Doctors will be encouraged to talk with patients about "risk-enhancing factors" that can provide a more personalized perspective of their risk.

Patients will still be checked for smoking, high blood pressure and high blood sugar, but doctors also should talk about other risk factors like family history, ethnicity, metabolic syndrome, chronic kidney disease, chronic inflammatory conditions and premature menopause or preeclampsia.

This additional information can make a difference in what kind of treatment plan a person needs, the guidelines say.

These risk-enhancing factors make the guidelines more complex, but also highlight important differences in heart risk among people, Gulati said.

For example, it's important to know about things like preeclampsia or gestational diabetes when assessing a woman's heart risk, Gulati said.

"These are things that we in our women's heart centers are asking about, but we've never had somebody backing us up that these are things that should make us be more aggressive," Gulati said.

Calcium may be key

For those whose heart risk is moderate, the guidelines now call for coronary artery calcium (CAC) scans as a "tie-breaker" to help assess the health of their arteries. CAC is a type of CT scan that looks for calcified plaque in the arteries.

People with a CAC score of zero -- no plaques at all -- might be able to forego or delay taking statins unless they have some other risk factor, said Dr. Sidney Smith, a professor of cardiology with the University of North Carolina School of Medicine.

In most cases where the CAC score is zero, adults have 10-year risk rates below the range where statins provide a net benefit, the guidelines say.

"I have seen patients with coronary calcium scores of zero, and I suggested they may not need to be taking a statin," said Smith, who served on the guideline committee. "A finding of zero can be very helpful."

Risk factors that would indicate a need for statins would include smoking, diabetes or a strong family history of heart disease.

The radiation involved in a CAC scan is similar to that of a mammogram, Stone noted.

The updated guidelines also introduce other cholesterol-lowering drugs besides statins.

What about costs?

Drugs like ezetimibe or PCSK9 inhibitors should be considered for people who've already had a heart attack or stroke and have LDL levels 70 or higher despite taking as much statin as they can stand, the guidelines say.

The guidelines call for first adding ezetimibe, which is now generic, and then adding more costly PCSK9 inhibitors if cholesterol levels still remain high.

PCSK9 inhibitors, which include drugs such as Praluent or Repatha, come with price tags of between $4,500 to $8,000 per year.

Partly for that reason, the use of these drugs should be reserved for those at highest risk, the guidelines say.

"There have been concerns over the cost of PCSK9 inhibitors and some insurance companies have been slow to cover them, so it's important to note that the economic value of these new medications may be substantial only for a very specific group of people for whom other treatments haven't worked," Benjamin said.

The guidelines are complicated for good reasons, but now the next challenge will be to boil them down for front-line physicians and families, Gulati said.

"It looks a little overwhelmingly complicated. We need to figure out a simple way to translate it to everybody, including patients," Gulati said.

More information

For more on coronary artery calcium testing, visit University of Maryland Medical Center.


Amazon Smile

To quit smoking, call Connecticut QuitLine at 1-800-QUIT-NOW.

Children and Adult services are available now with no wait time.  Please contact HBH Intake Department at 860-548-0101, option 2.


powered by centersite dot net