Understanding the latest cholesterol guidelines can be quite confusing if you’re not a healthcare professional or have no prior knowledge on the topic.

In 2018, the American Heart Association (AHA) and the American College of Cardiology (ACC) published new recommendations for the management of cholesterol. These guidelines have significant implications for cholesterol management among healthcare practitioners and the general population.

The Basics of Cholesterol

Before we delve into the latest cholesterol guidelines, let’s first understand the basics of cholesterol.

Cholesterol is a fatty substance that is produced naturally by the liver and is an essential component of our cell membranes and can also produce hormones.

The cholesterol molecule consists of two important components, namely:

• Low-density lipoprotein (LDL) – commonly referred to as ‘bad cholesterol’ as it contributes to the buildup of plaque in the arteries.
• High-density lipoprotein (HDL) – commonly known as ‘good cholesterol’ as its role is to transport excess cholesterol from the bloodstream back to the liver.

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Cholesterol Guidelines: The Old versus the New

The previous cholesterol guidelines were published in 2013. The guidelines aimed to reduce the risk of heart disease by managing the patient’s cholesterol levels.

According to the 2013 guidelines, the goal for cholesterol treatment was to achieve an LDL level of fewer than 100 milligrams per deciliter (mg/dL) for people who are at high risk of heart disease.

For individuals who are at intermediate risk for heart disease, the target LDL level was set at less than 130 mg/dL. The 2013 guidelines also helped practitioners in deciding when to start medication to lower cholesterol levels based on an individual’s risk of heart disease.

The new cholesterol guidelines are based on robust scientific evidence gathered over the years.

The primary aim of the updated guidelines is to develop a more personalized approach to cholesterol management that is tailored to an individual’s risk of developing heart disease.

The Four Main Groups

The American Heart Association (AHA) and American College of Cardiology (ACC) guidelines propose that an individual’s risk of cardiovascular disease (CVD) be evaluated based on their age, sex, blood pressure, blood sugar, smoking status, and cholesterol levels.

There are four main groups that have been identified:.

1. People who have the highest risk of developing heart disease.
2. People who already have heart disease or have had a stroke.
3. People whose levels of LDL fall between 70mg/dL – 189mg/dL.
4. People who have low risk with LDL between 70mg/dL – 189mg/dL.

Group 1: People who have the highest risk of developing heart disease

This group mainly consists of individuals with a family history of heart disease or severe lifestyle factors, such as smoking, in addition to high cholesterol levels.

The guidelines recommend that individuals in group 1 should target an LDL level of fewer than 70 mg/dL. This lower LDL level has been demonstrated to decrease the risk of cardiovascular events and promote the formation of plaque within the arteries. This group also has the highest potential benefits of using high-intensity statin therapy.

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Group 2: People who already have heart disease or have had a stroke

People who already have a history of heart disease or stroke are at an increased risk of cardiovascular events and require aggressive management. The guidelines recommend lowering their LDL to less than 70 mg/dL.

The use of high-intensity statin therapy is also recommended to reduce the risk of further complications.

Group 3: People whose levels of LDL fall between 70mg/dL – 189mg/dL

This group consists of people who have LDL levels that fall within the ‘normal range,’ but are still at risk of heart disease due to other risk factors such as age, sex, smoking status or family history of heart disease.

The guidelines suggest that individuals in this group should take a risk calculator test and should be given moderate to high-intensity statin therapy, dependent on the outcome. The goal of this treatment is to lower the individual’s LDL levels by 50% or more.

Group 4: People who have low risk with LDL between 70mg/dL – 189mg/dL

People in this group are at low risk of developing heart disease. They have an LDL level that falls within the normal range and should focus on lifestyle adjustments to promote heart health, such as healthy nutrition and regular physical activity.

The guidelines suggest that healthcare practitioners should focus on educating and motivating individuals from this group to maintain a healthy lifestyle to curb the risk factors that may lead to heart disease.

Taking Statin Therapy

Statins are drugs that play a significant role in the management of cardiovascular disease. Statin treatment aims to reduce the body’s production of cholesterol.

Evidence has demonstrated statin therapy’s ability to lower LDL levels, that minimizes the risk of serious cardiovascular events.

The updated cholesterol guidelines highly recommend high-intensity statin therapy for people who have a history of cardiovascular disease or are at high risk of developing heart disease.

For people who have not experienced cardiovascular events but have risk factors such as Diabetes or kidney disease, moderate to high-intensity statin therapy is recommended.

Controversies

The updated cholesterol guidelines have been met with some controversies. The cholesterol treatment panel in the National Lipid Association recommended that people over the age of 75 should not be on statin therapy.

This conflicting recommendation with the new Cholesterol Guidelines has caused some confusion among healthcare practitioners. However, the updated cholesterol guidelines recommend discussing the potential benefits and adverse effects of statin therapy with each patient to determine its priority of practice.

Conclusion

The updated cholesterol guidelines aim to offer healthcare practitioners and individuals a personalized approach to manage cholesterol.

The guidelines take into account various factors that determine the risk of developing heart disease and have identified different groups of individuals who warrant distinct cholesterol treatments. Proper management of cholesterol may offer a reduction in the prevalence of cardiovascular disease and promote heart health.