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 ASCVD.
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 cardiovascular disease.
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 atwww.heart.org).
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 call.
Dr. Eslami is a Cardiologist and Director of Cardiovascular Services at
Hoag Hospital Irvine.