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New cholesterol guidelines offer a more flexible approach

New cholesterol guidelines offer a more flexible approachChris Hondros / 2010 Getty Images

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(CNN) – New Cholesterol Guidelines recommend a personalized approach to risk assessment, focused focus on targeted LDL levels and new drug options for those with the highest risk of cardiovascular disease. The guidelines were announced on Saturday during the annual Scientific Conference of the American Heart Association.

Recommendations proposed by the American Heart Association and the American College of Cardiology discussed the value of the use of calcium coronary artery for some patients and extended the age limit for treatment.

"High cholesterol levels are not the same size for everyone, and this guideline strongly confirms the importance of personalized care," said Dr. Michael Valentine, President of the American College of Cardiology.

"Over the past five years, we have learned more about new treatment options and which patients can benefit from them," he said. "By providing a plan for treating clinicians, we provide them with tools to help their patients understand and manage their risk and to live longer, healthier lives."

Criticism of previous guidelines

The new recommendations relate to many of the problems that were set when the guidelines were last updated five years ago.

These guidelines for 2013 were disturbing for many reasons, explained Dr Steven Nissen, Cardiovascular Medicine Chairperson at Cleveland Clinic. The previous guidelines used a risk calculator that left key components such as family history; they did not deal with issues of persons older than 75 years or younger than 40; exceeded the risks faced by many patients lowering the threshold required for the treatment of statin drugs; and eliminated the use of LDL (bad) target cholesterol levels, which helped patients set meaningful goals.

People with LDL levels of 100 or below, "tend to have lower rates of cardiac disease and stroke, backed up by the" lower is the better "philosophy," says medical organizations about new guidelines.

The level above 160 is considered to be "very high", according to release from Johns Hopkins Medicine, which also outlined new guidelines. For high risk patients, the recommendation is to reduce "bad" cholesterol to levels below 70 years.

If statin therapy fails to lower the level of LDL adequately, in patients who already had a heart attack or stroke, new guidelines point to the addition of other drugs – ezetimibe, which is available as a generic – in regimen. If this combination does not work enough for patients with a very high risk, a PCSK9 inhibitor may be added.

The new approach encourages increased co-operation between doctors and their patients. Physicians are encouraged to discuss a wide range of risk factors, such as family history and ethnicity, as well as other conditions including metabolic syndrome, premature menopause and chronic kidney disease.

The influence of high cholesterol on all age groups

Physicians are also called to look at the patient's life expectancy and how much cholesterol is taking the toll. Children born in particularly high-risk families can be tested when they are younger than 2 years old. For most children, however, it is recommended that an initial examination be made between the ages of 9 and 11, and then a trial test at the age of 17 and 21.

And as the cholesterol level in younger people should not be neglected, the same goes for those over 75, suggest new recommendations.

"Now they recognize that it would be appropriate to treat older people," something they did not do in 2013, Nissen said, who was very critical of the last round of guidance. "Today's 75-year-old can live long."

All these events are good signs, "step forward," Nissen said. "It's been five years to solve problems with the latest set of guidelines, but I'm glad they've solved them."

Nissen offered only one critique of new recommendations: the proposal that coronary artery calcification is used to determine the need to lower cholesterol in patients whose need is unclear. This result shows the accumulation of plaque in the arteries and is determined by CT, which can cost between $ 800 and $ 1,000, he said.

"Do somebody to decide whether to use a drug that costs only $ 3 a month, and you spend a lot of money on it," he said. "I do not think he's smart."

But besides, Nissen is pleased. "The big picture is that this is a reasonable set of guidelines," he said.

Heart disease is the leading cause of death in the United States, according to US Centers for Disease Control and Prevention. Cardiovascular disease, involving heart attacks and stroke, makes more than 836,000 deaths annually, according to the American Heart Association and the American Stroke Association.

"Having high cholesterol at any age increases this risk significantly," said Dr. Ivor Benjamin, president of the American Heart Association, in a written statement. "That's why it's so important that even in young people people follow the heart of a healthy lifestyle and understand and maintain healthy levels of cholesterol."

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