Wednesday , January 20 2021

New guidelines for cholesterol management require personalized risk assessments



Leading cardiac experts published Saturday's cholesterol management guidelines that urge doctors to adjust treatment to better personalized risk assessments for each patient and recommend the use of two new types of drugs for those at greatest risk of illness.

Recommendations are upgraded Guidelines issued in 2013 that fundamentally altered the way in which health workers determine the patient's risk of heart attack and cardiovascular disease. In this landing document, experts told doctors to stop trying to reduce their cholesterol numbers to specific targets and instead track the overall matrix trying to predict their future risk of problems.

The new guidelines give clinicians a better idea of ​​how to do it through treatment categories that differ depending on cholesterol and, if necessary, other tests. A 121-page document was released Saturday in the American Heart Association in scientific sessions in Chicago in 2018 and published in the journal Circulation Journal of the American College of Cardiology and Journalism.

"We essentially support and expand the scope of the risk discussion," said Neil J. Stone, vice president of the board who wrote guidelines and a professor of cardiology at the Feinberg Medical School at Northwestern University.

For example, guidelines recommend high-intensity statin therapy for people under the age of 75 who are determined to have atherosclerotic cardiovascular disease in order to reduce their low-density lipoprotein (LDL) or "bad" cholesterol by 50 percent. In people aged 40-75 with diabetes, the "moderate intensity" therapy of the statin is indicated regardless of the 10-year risk of a patient's disease, according to another recommendation.

Heart disease is the leading killer of Americans. Almost a third of all adults in the United States have high levels of LDL, which is the main cause of fatty deposits in the arteries leading to heart attacks, strokes and other cardiovascular problems.

New recommendations confirm the leading principles of heart health that are "lower in quality" when it comes to LDL, and that people should try to achieve this first by living a healthy lifestyle, starting from childhood. This includes diet and exercise, blood pressure control and smoking avoidance, among other measures.

When these steps are not sufficient, the guidelines reaffirm the stats as the cornerstone of preventive treatment for people at risk of illness. About 43 million people in the United States take statins to reduce LDL levels. Drugs are recognized to reduce the risk of heart attack and stroke.

Two drugs have been developed from the latest guidelines published in 2013, and the panel has confirmed their use in cases where statins are not sufficient. For people who have suffered a heart attack or have many risky conditions, experts suggest the addition of ezetimibe. Lek, which is marketed as Zetia, but also available in generic form, reduces the amount of cholesterol absorbed in the small intestine.

In some cases, experts also recommend the use of PCSK9 inhibitors, potent drugs approved by the Food and Drug Administration in 2015 that block a substance that prevents the ability of the liver to remove LDL from the blood. Drugs, which are mainly used to treat inherited disorders that cause very early heart attacks, are vastly expensive, and the panel has offered doctors a way of assessing their value.

The Committee estimates that PCSK9 inhibitors cost more than $ 150,000 for each good year of life.

When doctors have a hard time deciding how to treat patients, the committee suggests calcium tests on the coronary artery can help determine how much plaque is built on the walls of certain blood vessels. They have been able to start cholesterol testing much earlier in life to identify children at risk of developing heart disease.


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