Repertoire readers may find renewed interest in lipid testing on the part of their customers as a result of new cholesterol guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC). The guidelines were presented at the AHA’s 2018 Scientific Sessions in November, and published in Circulation (the AHA journal) and the Journal of the American College of Cardiology.
“They build on the major shift we made in our 2013 cholesterol recommendations, to focus on identifying and addressing lifetime risks for cardiovascular disease,” Ivor Benjamin, M.D., FAHA, president of the AHA, was quoted as saying.
In addition to talking to patients about traditional risk factors, such as smoking, high blood pressure and high blood sugar, the guidelines urge doctors to talk about “risk-enhancing factors,” which can provide a more personalized perspective of a person’s risk. Such factors include family history and ethnicity, as well as certain health conditions, such as metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or pre-eclampsia and high lipid biomarkers. This additional information can make a difference in what kind of treatment plan a person needs.
When high cholesterol can’t be controlled by diet or exercise, the first line of treatment is typically statins, mostly available in generic forms and long-proven to safely and effectively lower low-density lipoprotein cholesterol (LDL-C) levels and cardiovascular disease (CVD) risk. For people who have already had a heart attack or stroke and are at highest risk for another and whose LDL-C levels are not adequately lowered by statin therapy, the guidelines recommend the use of other cholesterol-lowing drugs that can be added to a statin regimen.
Ongoing testing advised
Once treatment has been started (either lifestyle modifications or medication therapy), adherence and effectiveness should be assessed at four to 12 weeks with a fasting lipid test, then retested every three to 12 months based on determined needs.
Selective cholesterol testing is appropriate for children as young as two who have a family history of heart disease or high cholesterol, according to the guidelines. In most children, an initial test can be considered between the ages of nine and 11 and then again between 17 and 21. Because of a lack of sufficient evidence in young adults, there are no specific recommendations for that age group.
Nearly one of every three American adults has high levels of LDL-C, considered the “bad” cholesterol because it contributes to fatty plaque buildups and narrowing of the arteries, according to the American Heart Association. About 94.6 million, or 39.7 percent, of American adults have total cholesterol of 200 mg/dL or higher, while research shows that people with LDL-C levels of 100 mg/dL or lower tend to have lower rates of heart disease and stroke, supporting a “lower is better” philosophy.
Editor’s note: The AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” was published Nov. 10, 2018, in Circulation. It can be viewed at https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625