2018 Guideline on the Management of Blood Cholesterol
28
August

By Adem Lewis / in , , /


(gentle, melodic music) – I am Scott Grundy, a Professor of Internal Medicine at the University of Texas
Southwestern Medical Center and VA Medical Center in Dallas. I am Chair of the Writing Committee of the 2018 Cholesterol Guidelines, which are sponsored by the
American College of Cardiology and American Heart Association. Several other related organizations have contributed to the
writing of this guideline. The online version of this guideline is being published today in
the Journal of Circulation and the Journal of the
American College of Cardiology. Our guidelines incorporate new science and new clinical trials that have been published since 2013. These allow for a revision and updating of the 2013 guidelines. The foundation of cholesterol guidelines is a healthy lifestyle. Lifestyle intervention
is emphasized regardless of whether cholesterol
lowering drugs are recommended. Lifestyle includes
cholesterol lowering diet, weight control, regular physical activity, and avoidance of cigarette smoking. For drug therapy, statins
are the first line drugs. They can be life saving for those patients at risk
for atherosclerotic disease. For high risk patients, like
those with vascular disease, high intensity statins are preferred. For primary prevention in
patients at intermediate risk, moderate intensity statins can be used. For primary prevention, a 10 year risk for heart attack and stroke is calculated with the risk calculator. This calculator makes use
of the major risk factors, like smoking, high blood
pressure, and diabetes. Patients are divided into
high risk, intermediate risk, borderline risk, and low risk. Patients at high risk generally should go
directly to statin therapy, so should patients with diabetes
or very high LDL levels. Intermediate risk patients
should discuss with their doctor whether to use statins. The clinician should consider all the risk factors affecting risk besides the major risk factors. Some of these factors may tip
the balance to using statins. If risk remains uncertain,
as a last resort the patient can have
measurement of coronary calcium. Coronary artery calcium measurements are an indication of the amount
of atherosclerosis present. If the level is zero, it may be possible to
avoid statins altogether. If calcium is present,
statin therapy is favored. Our new guidelines put greater emphasis on detecting high blood
cholesterol and high lifetime risk earlier in life. In children and young adults, early intervention on risk factors can delay onset of heart disease
and stroke later in life. Once treatment is started, the effects should be
monitored and reinforced regularly throughout life. Too few people adhere
to effective treatment in the long run. A sizeable portion of patients
treated with the statins complain of side effects. These should be carefully evaluated and appropriately managed. In many patients, real or perceived side effects
can be effectively treated. High blood cholesterol is one
of the major risk factors. Others are high blood
pressure, cigarette smoking, diabetes, obesity, and
physical inactivity. The American Heart Association
strives to develop strategies for control of these factors for both clinical practice
and the general public. We congratulate our
outstanding Writing Panel, and American Heart Association
team of professionals in the development of our
cholesterol guidelines. (gentle, melodic music)


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