Lower overall heartattack and stroke risk, not just cholesterol
After lifestyle changes, cholesterol-lowering statin drugs could benefit about 33 million Americans who have a greater than 7.5 percent 10-year risk for heart attack and stroke. The term “ASCVD” in this guideline refers to the type of cardiovascular disease caused by atherosclerosis, or hardening of the arteries, that can lead to heart attack or stroke.
The guideline recommends that patients and their healthcare providers assess the patient’s risk of ASCVD events, and then discuss treatment options, including patient preferences. It also describes four major groups of people whose benefit from lowering their heart attack or stroke risk would clearly outweigh the risk of side effects from statin medications. These include patients: 1) with diagnosed ASCVD; 2) with LDL, or “bad,” cholesterol of more than 190 mg/dL with no secondary cause; 3) who are 40-75 years old with type 2 diabetes, an LDL cholesterol of 70 to 189 mg/dL, and don’t have diagnosed ASCVD; and 4) who have an estimated 10-year risk of ASCVD of more than 7.5 percent, but don’t have diagnosed ASCVD or type 2 diabetes with the LDL levels described above.
Treating for higher overall risk using the criteria in the guideline will replace the previous approach of treating LDL cholesterol to a specific target level.
Assessing risk of heart attack and stroke in more people
Updated risk equations for white men and women — and a new risk equation for African-Americans — were published in the risk assessment guideline. To calculate 10-year risk, the equations use race, gender, age, total cholesterol, HDL “good” cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status. Importantly, stroke risk is included, giving patients a better assessment of their future cardiovascular health.
Lifestyle guidelines: dietary patterns and exercise
Lifestyle recommendations target the many people who need to lower cholesterol and blood pressure. They recommend an overall heart-healthy dietary pattern and 40 minutes of moderate to vigorous aerobic exercise three to four times a week. Dietary patterns should emphasize fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts, and limit red meat and sugary foods and beverages. To lower blood pressure, the guideline recommends a step-down approach to no more than 2,400 milligrams of sodium a day. To lower it further, the guidelines recommend getting sodium down to 1,500 mg a day.