New Cholesterol Guidelines: New Insights

Five years into the making, the new cholesterol guidelines build upon the previous 2 guidelines that were released in 2001 and 2013, respectively.  The new guidelines focus on proven cholesterol-lowering therapies that reduce the risk of cardiovascular disease including myocardial infarction (heart attack), stroke, coronary bypass surgery, etc.   Having worked in the cholesterol field for the past 3 decades,  I will share some insights as to why the new guidelines have been well received to date.

1. Lowering high levels of LDL (bad cholesterol) reduces risk: At birth, the average LDL is ~30 mg/dL.  These levels will rise to ~50-70 mg/dL by a child’s 1st birthday.  In fact, if we maintain these “physiologic” LDL levels throughout life, the overall risk of heart related problems is low, provided we live a healthy lifestyle and don’t smoke cigarettes,  be physically active, manage our stress levels etc.  If you have heart disease, the new guidelines recommend to lower your LDL intensively (by at least 50% from your starting point) and to attain levels below 70 mg/dL. If you don’t have a history of heart-related problems but are at increased risk, the new guidelines recommend to lower your LDL in some cases to less than 100 mg/dL.
2. Lifestyle represents the initial treatment for high LDL: Try foods that lower LDL.  They include barley, beans and brussels sprouts (for a full list of the best LDL lowering foods, check out “Heal Your Heart“).
3. Statins represent the primary medication for treating high LDL:  When lifestyle fails to effectively lower LDL, statins are the medications of choice.  I will discuss statins in greater detail in an upcoming blog but the bottom line is this- statins have a decades long track record; study-after-study have consistently demonstrated reduction in cardiovascular risk.  Depending upon your level of risk, discuss with your physician or health care professional whether statin therapy is the right choice for you.
4. Newer non-statin therapies may now be considered if LDL levels remain elevated: The new cholesterol guidelines now recommend that if LDL levels remain elevated after diet and statin therapy or if statins are not (well) tolerated, to consider non-statin LDL lowering therapies.  These include ezetimibe and the PCSK9 inhibitors.  Both of these therapies add incremental benefit to statins and further reduce cardiovascular risk beyond lifestyle and statin treatment alone.
5. We’ve come a long way over the past 30 years.  When I entered this field, statins were not yet available and treatment options for high LDL were much less effective and not as well tolerated.    The new cholesterol guidelines build upon decades of testing and experience in this field.  It has been my privilege to have witnessed first hand the great strides made in men and women with high LDL who are now able to reduce levels to a normal range and reduce their cardiovascular risk.
6. Michael Miller, MD is a tenured Professor of Cardiovascular Medicine, Epidemiology & Public Health at the University of Maryland School of Medicine in Baltimore, Maryland USA.