Eleven major medical organizations have issued new guidelines for managing cholesterol and screening for heart disease at a much earlier age than previously recommended.
Experts say the update has caught up with the science on how best to prevent and treat cardiovascular disease, which is responsible for about one in three deaths in the U.S.
"We need to do more to prevent cardiovascular disease, because it's still the number one killer of men and women," says Nathaniel Lebowitz, MD, a cardiologist at Hackensack University Medical Center. "These guidelines should make a big impact."
Here’s a breakdown of the changes and why you may want to bring them up at your next doctor’s appointment.
Earlier intervention for high cholesterol
One of the biggest changes recommended by the American Heart Association, American College of Cardiology, and other professional groups is to begin treating high cholesterol as early as age 30. Elevated levels of LDL cholesterol, known commonly as “bad” cholesterol, is a major risk factor for heart disease, and the longer people live with it, the more damage it can cause.
“We now understand that heart disease begins decades before the first symptom,” says Michael Shapiro, DO, a professor of cardiology at Wake Forest University and a member of the committee that assembled the guidelines. “Cholesterol exposure accumulates over time, so the earlier you identify and manage risk, the greater the lifetime benefit.”
The guidance still suggests managing cholesterol with exercise and a heart-healthy diet, but there are a growing list of options for people with stubbornly high levels of LDL — from statins, a common medication which blocks an enzyme the liver needs to produce cholesterol, to newer drugs like Ezetimibe, which prevents the absorption of cholesterol.
The average LDL level in the U.S. is about 110, although everyone should aim to keep their LDL under 100. And according to the new guidance, “lower is better,” Dr. Lebowitz says. That may seem intuitive, but there had previously been some concern that significantly low LDL may be bad for the brain, Dr. Lebowitz says.
Recent research shows that’s not the case: “Very low LDL doesn’t lead to dementia or any other neurological problems. It does, however, lead to a lack of cardiovascular disease,” he tells us.
Screening for lipoprotein(a)
It’s now recommended that everyone have their levels of lipoprotein(a) — or Lp(a) — tested at least once in adulthood. Lp(a) is a cholesterol-carrying particle, and the levels you carry are highly dependent on your genetics and remain mostly stable throughout your life.
It’s estimated that 20 to 30 percent of people have naturally high levels of Lp(a), and rates among African Americans are even higher, ranging from 30 to 50 percent. Screening for it is already part of standard practice in Europe and Canada, and many experts believe it’s about time the U.S. caught up.
Lp(a) screening isn’t part of a typical lipid panel, but it can be measured with a simple blood test. If you haven’t been tested already, Dr. Lebowitz recommends you ask your health care provider. And if you're part of the one-in-five with high Lp(a), you should urge your parents, siblings, and children to get tested, too.
“This is a big change,” Dr. Lebowitz says. “We’re going to be identifying a lot of people at risk, and hopefully saving millions of lives.”
