Exposure to high blood cholesterol over a lifetime can increase the risk for heart attack or stroke, and new scientific guidelines say managing this waxy, fat-like substance in the blood should be a concern for all ages.
The guidelines, published Saturday in the journal Circulation, are meant to help health care providers prevent, diagnose and treat high cholesterol.
A panel of 24 science and health experts from the American Heart Association and 11 other health organizations wrote the guidelines’ science-based recommendations for people with very specific conditions and risks.
Nearly one of every three American adults have high levels of LDL, the so-called “bad” cholesterol that contributes to fatty buildup and narrowing of the arteries, called atherosclerosis.
Global and U.S. studies have suggested the optimal level is less than 100 mg/dL (milligrams per deciliter) for otherwise healthy people, and research trials have shown people with an increased risk of heart disease are less likely to develop heart disease and stroke when given drugs to lower elevated levels of LDL.
Along with well-established risk factors such as smoking, high blood pressure and high blood sugar, the guidelines suggest also looking at “risk-enhancing factors” such as family history and other health conditions to provide a better perspective of a person’s overall risk during the next 10 years.
The guidelines recommend doctors use a calculator to give a detailed assessment of a person’s 10-year risk for heart disease and to help create a personalized plan.
For most patients who can’t control the condition with diet and exercise, a cholesterol-reducing drug called a statin can be used.
For patients at very high risk, including those who already have coronary heart disease, stroke or very high cholesterol caused by genetic conditions, additional drugs called ezetimibe and PCSK9 inhibitors can be used.
For people 40 to 75 years old without evident heart disease, the guidelines use four classifications of risk: low, borderline, intermediate and high.
When a patient is in the intermediate zone, and sometimes on the borderline, the guidelines suggest doctors have an in-depth discussion with patients about potential benefits of statin drugs, considering all risk factors.
If uncertainty remains about whether to use a statin, doctors can consider delving further with a test called a coronary artery calcium, or CAC, screening.
A CAC score is calculated based on taking a CT scan of the heart and determining how much calcium plaque is building up in the heart’s arteries.
For younger adults between 20 and 39, the guidelines emphasize a healthy lifestyle, maintaining a healthy diet and weight and exercising regularly.
Because of a lack of long-term research for this younger age group, statin recommendations are reserved for those at higher risk.
But that doesn’t mean those patients should be ignored, because young adults with risk factors like high cholesterol often already show the first stages of atherosclerosis.
Because of the potentially dangerous effects of a lifetime exposure to high cholesterol, particularly LDL, the guidelines suggest doctors consider selective screenings of children as young as 2 who have a family history of early heart disease or high cholesterol.
In children without any known risk factors, doctors could recommend tests between the ages of 9 and 11 and then again between 17 and 21.
People at age 20 with normal heart health have a better chance of making it to 50 with normal cardiovascular health factors.
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