New guidelines suggest a ‘lifespan approach’ to battle high cholesterol

Doctors should look beyond typical risk factors for high cholesterol, creating detailed personal plans for individuals to examine risks early, suggest new guidelines published Saturday.

The guidelines, available in the journal Circulation, say health factors such as family history should be taken into account when examining a person’s risk for high cholesterol.

The guidelines for treating high cholesterol, which affects nearly one in three American adults, were pulled together by experts from the American Heart Association and 11 other health organizations.

Experts suggest a “lifespan approach” to treating cholesterol, said Dr. Sarah D. de Ferranti, chief of outpatient cardiology and director of preventive cardiology at Harvard Medical School’s Boston Children’s Hospital, in a statement.

The guidelines suggest doctors consider screening for kids as young as 2 years old with a family history of early heart disease and high cholesterol.

“It’s important that, even at a young age, people are following a heart-healthy lifestyle and understanding and maintaining healthy cholesterol levels,” said de Ferranti.

For younger people, guidelines advise doctors emphasize healthier lifestyles and maintaining the right weight to keep their cholesterol in check. For people 40 and older without heart disease, doctors should discuss taking statins – drugs which help control cholesterol levels – based on their risk.

“The truth about clinical medicine is there is no black and white. It’s all gray,” said Dr. Donald Lloyd-Jones, a writing committee member and chair of the department of preventive medicine at Northwestern University in Chicago, in a statement.

“That’s why the emphasis in this document is making sure the patient and doctor are having well-informed discussions about the benefits and the potential risks of drug therapy.”

According to the AHA, the optimal level of LDL, or “bad” cholesterol, is less than 100 mg/dL.

The last time the AHA and American College of Cardiology updated their guidelines was 2013, which made twice as many Americans eligible to take statins. A week after those guidelines were published, two Harvard Medical School professors questioned whether formulas used to determine high cholesterol might overestimate people’s risk.

Dr. Steven Nissen, chairman of the department of cardiovascular medicine at The Cleveland Clinic and critic of the 2013 guidelines said the latest revisions represent a “great improvement” over the guidelines issued five years ago.

Nissen said the key additions include thresholds for treating patients with high cholesterol, and better guidance for treating people over 75 years old and under 40.

“It’s much more in line with what a lot of us think should have been done in 2013,” he said.


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