These new guidelines can help you estimate—and lower—your risk of a future heart attack.
The numbers are alarming: about every 40 seconds, someone in the United States has a heart attack. But many of these events are linked to factors you can control—including unhealthy levels of cholesterol and other fats (lipids) circulating in your bloodstream. New guidelines from 11 major heart and medical organizations provide a road map for addressing this common problem. The cholesterol guideline describes tools and tests to estimate your risk of a heart attack, provides updated targets for LDL (bad) cholesterol, and offers advice about reaching those targets. One important change from previous guidelines is an emphasis on identifying and preventing heart-related risks earlier in life. Most heart attacks don’t happen until people are in their 60s and 70s, but the process that fuels heart disease starts much earlier in life. You can lower your risk no matter what your age. But encourage your children and grandchildren to check their cholesterol, especially if heart disease runs in your family.
THE PREVENT CALCULATOR: ESTIMATE YOUR RISK
LDL cholesterol plays a big role in the buildup of fatty plaque inside the heart’s arteries (the underlying cause of most heart attacks). But factors like age, sex, blood pressure, body size, and whether you smoke or have diabetes also influence your risk. To gauge one’s risk of developing cardiovascular disease (CVD), you or your doctor can use the American Heart Association’s free online PREVENT calculator, which takes all those factors (and others) into account. If you’re 30 to 59 years old, the calculator estimates both your 10-year and 30-year CVD risk. If you’re 60 or older, you’ll get just a 10-year estimate.
These are the 10-year risk categories:
► low: less than 3%
► borderline: 3% to less than 5%
► intermediate: 5% to less than 10%
► high: 10% or higher
EMBRACE HEALTHY HABITS
The guidelines encourage adopting lifestyle habits that lower heart disease risk, and the earlier you start, the better. Maintain a healthy weight, eat a plant-focused diet, exercise regularly, avoid tobacco, and prioritize sleep. If needed, take statins or other cholesterol-lowering drugs as recommended by your doctor to meet your LDL cholesterol goal.
Your doctor can help you set a target for LDL (bad) cholesterol, which depends on many factors
KNOW YOUR LDL TARGET
The new guidelines set clear targets for LDL cholesterol (either as specific values or as percent reductions) which are guided by the 10-year risk categories above. For example, to prevent a first heart attack, people with borderline or intermediate risk should aim for an LDL below 100 milligrams per deciliter (mg/dL). But for those at high risk, the LDL goal is under 70 mg/dL. And people who have already had a heart attack or stroke (among others whose risk is particularly high) should try to get their LDL less than 55 mg/dL. However, if you fall into the borderline risk category, that is, your 10-year risk score on the PREVENT calculator is 3% to 5%, you may want to review your so-called risk enhancers (see below) and ask your doctor whether any of them might influence your treatment.
PERSONALIZE AND REFINE YOUR RISK
If you have any of the following risk enhancers, your risk of heart disease is higher than people without these factors:
►family history of heart disease
► a chronic inflammatory condition, such as lupus or rheumatoid arthritis
► South Asian or Filipino ancestry
► reproductive-related risks, such as early menopause or pregnancy complications.
In addition, elevated levels of blood biomarkers associated with heart disease can also raise your risk. They include the following:
LIPOPROTEIN(a)
Also known as Lp(a), these fatty particles are similar to LDL but more dangerous. Lp(a) levels are largely genetically determined, and high levels can raise heart disease risk by as much as threefold, even in people with no other risks for heart disease. As the guidelines recommend, all adults should get an Lp(a) test at least once in their lifetime.
APOLIPOPROTEIN B (ApoB)
ApoB is a protein that’s attached to LDL molecules and other harmful fat particles in the blood. For people with certain health problems, including cardiovascular-kidney-metabolic syndrome, diabetes, or high triglycerides, an ApoB-value provides added detail about the type and number of artery-clogging particles in the bloodstream.
C-REACTIVE PROTEIN (CRP).
A high-sensitivity measurement of this biomarker, the hsCRP test, checks for evidence of chronic inflammation in the body, which is now widely acknowledged as a culprit in the development of heart disease. People with high CRP levels face an added risk, but healthy lifestyle changes and statins can help tame inflammation.
CONSIDER A CALCIUM SCAN
For men 40 and older and women 45 and older with an intermediate or borderline risk who are hesitant to start a statin, a specialized CT scan may be useful. Often called a coronary artery calcium (CAC) scan, the test looks for calcified plaque in the heart’s arteries. A score of 0 suggests a low risk of a heart attack in the near future so statin therapy is likely unnecessary. But the higher your calcium score, the greater your risk—and the results can guide your doctor’s recommendation for your treatment.
CHOLESTEROL TESTING: WHEN TO START
According to the new guidelines, testing for LDL (bad) cholesterol should start in childhood (around age 10) to identify uncommon genetic conditions that lead to extremely high cholesterol levels. For people with normal results, the next testing should happen between ages 18 and 20, with repeat screening every five years (and more often for people who have high LDL levels or diabetes). Starting at age 30, people should use the PREVENT calculator and make healthy lifestyle changes to keep their LDL cholesterol below 100 mg/dL. Those with very high LDL (160 mg/dL or higher) may need statins or other medications to reach that goal.
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Below is a link to obtain my books available for purchase (digital or print versions):
Website: https://radiantmortontavel.com/
To be placed on the mailing list for future blogs, contact: tavelmorton@gmail.com