If you have high cholesterol and you are not taking statins,
it is time to make a doctor’s appointment.
Recently, the American College of Cardiology and the American
Heart Association presented new guidelines for the prevention of heart attack
and stroke that greatly widen the net of people who could benefit from statin
therapy. Statins are a class of medication that mainly reduce the levels of
cholesterol and in the blood. High cholesterol can lead to hardening of the
arteries, chest pain, heart attack and stroke.
The new guidelines – which replace 11-year-old
recommendations – were met with immediate skepticism. While previous guidelines
supported using statins for secondary prevention of heart disease in men, the
new guidelines suggest statins are effective for both primary and secondary
prevention in patients of both sexes and all ages, and that they are more
effective for those with higher risk factors. The guidelines also discouraged
combination therapy because the additional value of agents other than
statins have not been established.
I attended the presentation in Dallas and, like many people,
I was wary at first. But the science is convincing: The guidelines were
generated by a great number of scientists and experts in the field who reviewed
the most recent literature and hard outcomes of randomized clinical trials and
meta-analyses of random clinical trials.
So, if your doctor uses the new guidelines to give you
medication, it is because in the next 10 years your risk of developing a heart
attack or stroke is high.
The new guidelines identify four types of people who would
best benefit from moderate- or high-intensity statin therapy:
1. People with atherosclerotic cardiovascular disease, or
2. People with LDL or
“bad” cholesterol levels over 190 mg/dL.
3. People between the ages of 40 and 75 with either Type 1
or Type 2 diabetes and LDL levels over 70 who don’t have atherosclerotic
4. People between 40 and 75 who have neither ASCVD or
diabetes, but who have LDL levels over 70 and have an estimated 10-year risk of
ASCVD of 7.5 percent or higher (you can check your risk with a risk calculator
These new guidelines might result in more people being put
on statins, but they will also help ensure that those people will benefit from
the drug. One of the things that impressed me is that for the first time,
African Americans, women and Hispanics are represented in the guidelines.
Also, previous guidelines recommended that doctors focus on
bringing “bad” cholesterol numbers down. The new recommendations de-emphasize
the numbers and instead suggest treating the individual intensely.
Not only should at-risk people receive statins, they often
need to overhaul their diet and exercise routines.
In my practice, I recommend sticking to a Mediterranean diet,
rich in fish, nuts, olive oil, vegetables and fruit, which has been shown to
reduce cardiovascular events by 70 percent and cancer by 60 percent.
As I have begun using the new guidelines in my practice, I
expected some resistance. After all, I was now telling patients they needed
medications that were not previously recommended for them. So far, though, the
reception has been positive.
So, if you wonder where you stand in terms of your risk of
heart disease, heart attack and stroke, go see your doctor.
And if you’re one of my patients, I’ll be expecting your
Dr. Eslami is a
Cardiologist and Director of Cardiovascular Services at Hoag Hospital Irvine.