New dyslipidemia guideline puts add-on testing, early screening in the spotlight
The American College of Cardiology, American Heart Association and several other leading U.S. healthcare organizations have collaborated on updated recommendations for the management of dyslipidemia.
An estimated one in four U.S. adults has high levels of low-density lipoprotein-cholesterol (LDL-C), the groups wrote. This highlights the importance of making healthy lifestyle choices and utilizing lipid-lowering medications when necessary to help reduce a person’s risk of developing atherosclerotic cardiovascular disease (ASCVD). Preventive cardiology has gained more and more momentum in recent years, and this updated guideline reflects that trend.
“We know 80% or more of cardiovascular disease is preventable, and elevated LDL-C, sometimes referred to as ‘bad’ cholesterol, is a major part of that risk,” Roger Blumenthal, MD, chair of the writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Hospital in Baltimore, said in a statement. “While we want to try to optimize healthy lifestyle habits as the first step to lower cholesterol, we realize that if lipid numbers aren’t within the desirable range after a period of lifestyle optimization, we should consider adding lipid-lowering medication earlier than we would have considered 10 years ago. And lower LDL-C for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk.”
Statin therapy is often the primary recommendation when prescribing medications to high-risk patients. However, the guideline also features updated details on the potential value of considering non-statin therapies when treating certain patients.
One key update compared to previous recommendations is the inclusion of a new way to estimate a patient’s risk of developing ASCVD. The Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) risk calculator was built to help guide cardiologist decisions when it comes to prescribing medications or considering other preventive measures.
“With this new assessment tool, we can better estimate cardiovascular risk using health information already obtained during an annual physical—cholesterol, blood pressure readings and other personal information such as age and health habits—and then further personalize the risk score for each individual by looking at ‘risk enhancers,’ which can help guide the need for lipid-lowering therapy,” Blumenthal said in the same statement.
Society recommendations embrace the potential value of additional testing
The new document also points to the benefits of ordering additional tests when appropriate. Non-contrast coronary artery calcium (CAC) scans, for example, can help evaluate certain borderline- or intermediate-risk patients for signs of subclinical calcium or plaque buildup. A patient’s CAC score will then help their care team determine if they should start statin therapy.
Lipoprotein (a) and apolipoprotein B—known as Lp(a) and apoB, respectively—can also be measured to evaluate a patient’s long-term cardiovascular health. Lp(a) levels are genetic, so a single measurement of a patient can often be enough to tell specialists what they need to know for the rest of that individual’s life. ApoB, meanwhile, can be even more predictive than LDL-C when trying to quantify risk in certain patient populations.
Other healthcare organizations that helped develop these guidelines include the American Association of Cardiovascular and Pulmonary Rehabilitation, Association of Black Cardiologists, American College of Preventive Medicine, American Diabetes Association, American Geriatrics Society, American Pharmacists Association, American Society for Preventive Cardiology, National Lipid Association, and Preventive Cardiovascular Nurses Association.
Cholesterol screening early in life linked to key benefits
Another key detail in this updated document is the value of evaluating patients for ASCVD risk early in life. In fact, cholesterol screening is recommended for children between the ages of 9 and 11 years old. The results of such screening can then help guide that patient’s healthcare for many years .
“The evidence base continues to grow and has demonstrated that people who maintain low levels of LDL-C and triglycerides at earlier ages are much less likely to develop atherosclerotic disease decades later,” Pamela Morris, MD, vice-chair of the writing committee and chair of cardiovascular disease prevention at The Medical University of South Carolina, said in the same statement. “Taking action early in life is critical because high cholesterol begins to impact your heart disease risk even in adolescence.”
Read the full document here.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.