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Cholesterol: Now Just One Piece of the Heart-Risk Puzzle

Whether or not you need to be on cholesterol-lowering medication is no longer tied solely to your cholesterol numbers.


Your Local Health | Written by BJ Towe
Cholesterol

Whether or not you need to be on cholesterol-lowering medication is no longer tied solely to your cholesterol numbers. The traditional approach to lowering risk of heart attack, stroke, and death has been to lower heart-clogging LDL (“bad cholesterol”) levels in the blood to less than 100 mg/dL — even less for some patients. But new guidelines released in November by the American Heart Association and the American College of Cardiology take a more holistic approach to when to prescribe cholesterol-lowering drugs.

“Your cholesterol number is still important, but it's now viewed as just one piece of the puzzle,” says James Lovell, D.O., a Cardiologist with The Iowa Clinic. “The focus has shifted to treating a patient's overall risk considering a variety of factors.”

Those factors include a person's sex; age; body mass index (BMI); family history of heart disease; total, HDL and LDL cholesterol; blood pressure; diabetes; fasting blood sugar levels; and smoking.

By putting many of those factors into an online risk calculator, an individual's 10-year risk for heart disease is determined. “If your result is a score of 7.5 percent or higher, you're considered at risk and would benefit from cholesterol-lowering medications,” Lovell says.

“One criticism of the new guidelines is that the new risk calculator is overly aggressive and will make a lot of patients eligible for the statin drugs who weren't eligible before,” says Lovell. “But if overestimating patient risk leads more people to take action toward better heart health, that's a good thing.”

Calculate Your Risk for Developing Heart Disease

Although not the same risk calculator that was used in developing the new guidelines, the American Heart Association offers a good online risk calculator. To calculate your 10-year risk,  visit heart.org/ and search for “Heart Attack Risk Assessment.

When Cholesterol-Lowering Drugs are Recommended

When demographic and lifestyle factors add up to a heightened risk for heart disease, cholesterol-reducing medications may be prescribed. However, the guidelines for those have also changed:

Non-statin drugs, such as Zetia®,  are no longer recommended for lowering cholesterol. “These are safe and do lower cholesterol, but they haven't been shown by studies to improve patient outcomes,”
says Cardiologist James Lovell, D.O.

Statin drugs (Lipitor®, Lescol®, Crestor®, and Zocor®, for example)
are now recommended for  people who fall into one of four groups:

1. Are between age 40 and 75 and score a 7.5% or more on the new risk calculator

2. Are diabetic and between the ages of 40 and 75

3. Have been diagnosed with heart disease

4. Have LDL levels of 190 mg/dL or more

If you currently take any cholesterol-lowering medication, ask your doctor how the new guidelines apply to you and what the best way is to reduce your risk of heart attack and stroke.

7 Ways to Reduce Risk

Khan stresses that living a heart-healthy lifestyle benefits both sexes:  “Both men and women can reduce their controllable risk factors.”  Here's how:

  • Eat a diet that's rich in fresh fruits and vegetables; low in saturated fat, trans fats, and cholesterol; and high in fiber. Limit salt and sodium.
  • Maintain a healthy weight. The Centers for Disease Control and Prevention offers body mass index (BMI) calculators for both adults and children at cdc.gov/healthyweight/assessing/bmi/.
  • Exercise to build heart muscle, lose or maintain weight, and lower cholesterol and blood pressure.
  • Know your numbers. Have your blood pressure and cholesterol checked regularly. If you have diabetes, closely monitor your blood sugar levels and get an A1C test about every 3 months.
  • Don't smoke. One year after quitting, your risk of heart disease is cut in half. After 15 years, your risk is nearly the same as in someone who has never smoked.
  • Limit alcohol use. Do not drink to excess.
  • Take your medicine. Follow your doctor's orders and don't skip doses.

“Me? Heart Disease?”

To say that Mary Gross, 61, was surprised to learn she has heart disease would be a colossal understatement.

Mary Gross, 61, is a runner. She's completed marathons and half-marathons, used her noon hour to run nearby trails, and often got together with friends to run 10 miles — just because she could. She eats right, doesn't smoke, and has no family history of heart disease. Last October 24, Gross had open heart surgery to bypass two clogged arteries.

“I'm still in shock that it happened to me,” Gross says. “But looking back, things are clearer.”

About a year ago, Gross noticed that her energy was waning and she generally felt fatigued. In July, she began having an intense pain that burned in her upper chest a few minutes into her runs. “The pain started about the same time that the trails became wooded. I chalked it up to allergies and the fact that I was getting older,” she says.

But these atypical symptoms of heart disease steadily worsened. Still, it wasn't until Gross visited a Sports Medicine provider for shoulder pain in September that she broached the subject — and even then, it was practically as an aside.

“He immediately said he'd work with my primary care doctor to set up a stress test,” Gross says. That led to her being referred to David Lemon, M.D., a Cardiologist with The Iowa Clinic. “The next thing I knew, I was having an angiogram, which was performed by Dr. Khan. That ultimately led to my having open heart surgery.”

“I'm great now. I'm up to running 1.5 miles without walking on the treadmill,” Gross says.

“If the way you feel is out of the norm, perhaps you're really tired and not able to perform as well, I'd really suggest that you get it checked out. I'm thankful that I had the pain that caused me to go to the doctor. If I would have had a heart attack, it probably would have been fatal,” she says.

Instead, she says her current primary care doctor, Kevin Cunningham, M.D., an Internist at The Iowa Clinic, believes she's “good to go for about another 40 years.”

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