Guidelines

Cholesterol Guideline: What You Need to Know (2018)

If you have high cholesterol, you have a higher chance of developing heart disease, or having a heart attack or stroke. Because there often are no symptoms, many people don’t even know that they have high levels of harmful cholesterol.

What is Cholesterol?
Cholesterol is a fat-like substance in your blood. Too much low-density lipoprotein (LDL) cholesterol, also called the "bad" cholesterol, can clog your arteries and make a heart attack or stroke more likely. Keeping levels of LDL cholesterol low is an important part of heart health.
To help patients better manage high cholesterol, experts have released new guidelines that reflect the latest research and treatments. Experts from the American College of Cardiology, American Heart Association and other health organizations wrote the guidelines, which update ones from 2013. 

Here are key points that patients should know about the 2018 Cholesterol Guideline.


Be Heart Healthy

A heart-healthy lifestyle is important at all ages to lower your risk of having a heart attack or a stroke. Atherosclerotic cardiovascular disease (ASCVD) develops because of a buildup of cholesterol, fat and other substances in the blood. Over time, this buildup (called plaque) can harden and narrow the arteries, and can cause a heart attack or stroke. The good news is that habits such as exercise, eating more fruits and vegetables while cutting fat, sugar and salt often can help prevent these heart problems.


Talk about Your Risk

You and your clinician should talk about your personal risk for heart disease or stroke to decide what to do. Cardiovascular risk is calculated using factors related to heart health including:

  • Age
  • Sex
  • Race
  • Cholesterol
  • Blood pressure (and whether you’re being treated for it)
  • If you have diabetes
  • If you smoke

Together, this information helps gauge your risk of having a heart attack or stroke or dying from one of these events in the next 10 years and over your lifetime. 

In addition to the major factors that make heart disease more likely, other information is important to the risk discussion. These “risk enhancers” include your family history, if you have chronic kidney disease, or had high blood pressure during pregnancy. 

If there are doubts about your level of risk, a test that measures coronary artery calcium can add useful information to the discussion. Coronary artery calcium, often referred to as CAC, is the amount of calcium that has built up along the inner lining of the heart’s arteries. A higher level of buildup is linked with greater risk of heart attack in the future. The test can help identify patients who may benefit the most from cholesterol-lowering medications. 

If you have high risk, you should consider treatment to lower your cholesterol.


Treatment

The reality is that no one approach works for everyone when it comes to managing cholesterol. The new guidelines offer advice about how to treat different types of patients. The process involves looking at a person’s risk and tailoring steps to his or her situation. 

For example, your race or ethnicity may affect your risk of heart disease. The 2018 guidelines explain in more detail than before how being Asian American, black, or Hispanic or Latino can factor into treatment choices. It makes sense to talk about that information when deciding which statin (first choice for medicine to lower cholesterol) to use or how big the dose should be.

Statins

The first line of treatment for patients with high risk — along with a healthy lifestyle — is medication to lower cholesterol, starting with statins. Statins have been used since the 1980s to help lower cholesterol and reduce risk for heart events.

Non-Statins

When statins cause side effects or don’t lower cholesterol as well as they should, other treatments may be added or offered. These options may include ezetemibe and PCSK9 inhibitors, which are non-statin drugs that also can reduce cholesterol and heart risk. However, these treatments are much newer and often given only to certain patients who don’t succeed with standard treatment or need additional cholesterol lowering given their risk of having a first or second heart attack or stroke.

Taking Your Medicine

About 56 million adults in the U.S. are taking or are eligible to take statins, according to a National Health and Nutrition Examination Survey. This number may change in light of the new 2018 Cholesterol Guideline. However, not all patients take their medicines as they should. It’s important for patients with high cholesterol to understand the need for treatment and, if given medicine, how to take it as directed.  

Go to www.CardioSmart.org/HighCholesterol to learn more about how to control your cholesterol and protect your heart. 

Read the full text of the 2018 Cholesterol Guideline.