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December 3, 2013 at 10:20 AMComments: 0 Faves: 0

New Cholesterol Guidelines: What You Should Know

By Dr. Jeff Chamberlain, MD More Blogs by This Author

There has been a lot of talk about the "new cholesterol guidelines" published by the American College of Cardiology (ACC) and the American Heart Association (AHA). If you read news media and blogs, you will get a lot of biased opinions on these guidelines.

In this blog series I will dig into research and cut through the biased opinions, bringing to light some interesting facts about cholesterol, strokes, and heart attacks. I will also discuss how a person can decide if starting a statin, or other cholesterol medication, is right for them.

The stated goal of the new guidelines is to reduce death and disability from Atherosclerotic Cardiovascular Disease (ASCVD)ASCVD

What are the new guidelines talking about?

The guidelines throw around some words that most of us don't use on a daily basis, so let's get some definitions out of the way:

  • Cardiovascular Disease (CVD): a term that lumps together diseases of the heart or blood vessels.
  • Atherosclerosis: when plaques build up in the arteries causing hardening of said arteries. These plaques block up the blood vessels, which in turn reduce the blood supply to the heart of brain.
  • Atherosclerotic Cardiovascular Disease (ASCVD): diseases of the heart and blood vessels that come from hardening of the arteries. These would include heart attacks (also called Myocardial Infarctions or MI), angina (chest pain from hardening of the arteries in the heart), and strokes.
  • Primary Prevention: doing things to prevent the first heart attack or stroke.
  • Secondary Prevention: doing things to prevent another heart attack or stroke in a person who has already had one.

Atherosclerotic Cardiovascular Disease Stats

  • #1: Cardiovascular disease is the number one cause of death worldwide. Having a heart attack or stroke is also a major cause of disability. Heart disease is the leading cause of death for both men and women.
  • 1 in 4: About 600,000 people die of heart disease in the United States every year. That's 1 in every 4 deaths.
  • 385,0000: The number of people who die of coronary heart disease (heart attack) each year - the most common type of heart disease.
  • 715,000: The number of Americans who have a heart attack each year.
  • $108.9 Billion: The cost of Coronary heart disease to the United States each year.
  • 130,000: The number of Americans killed by stroke each year.That's 1 in every 19 deaths.
  • 4: The number of minutes between American stroke deaths. On average, one American dies from stroke every 4 minutes.
  • 795,000: The number of people who have a stroke every year in the United States. About 610,000 of these are first, or new, strokes.
  • 1 in 4: The number of strokes that are recurrent.
  • 87%: the percentage of strokes that are considered "ischemic" - when blood clots block the blood vessels to the brain.
  • $38.6 Billion: The cost of strokes in the United States each year. This total includes the cost of health care services, medications, and missed days of work.

Non-modifiable Risk Factors (things we can't control)

I like to break down the risk factors for CVD into 2 groups: things we can't change (non-modifiable risk factors), and things we can change (modifiable risk factors).
Personal History: Unfortunately, if you already have a history of heart attack, stroke, peripheral vascular disease, or any other blockage of arteries, you have a much higher chance of having a new heart attack or stroke.

Family History: It is important to remember that, when looking at CVD risk, we need to look at our 1st degree relatives (father, mother, brother, or sister) who have a history of CVD at an early age. An early age is defined as a male younger than 55, or a female younger than 65. This means that if your dad had a heart attack when he was 75, it probably does not tell us very much about your risk of having a heart attack. But, if your sister had a heart attack at age 60, you are at an increased risk. These risk predictions are developed based on data, and are not perfect. For example: if all 5 of your uncles had heart attacks when they were 50, but your dad is now 70 and has not had a problem with his heart, then we have no idea if your risk for a heart attack is increased.

Age: With age comes an increased risk of having a heart attack or stroke. Although a healthy lifestyle can help reduce the effects of aging, there is nothing we can do to stop time.

Gender: Although there are a growing number of women who have heart attacks, males are still more likely to experience cardiovascular disease.

 Modifiable Risk Factors (things we can attempt to control)

Because it is so common, even a relatively small reduction in the rates of cardiovascular disease would drastically decrease the number of heart attacks and strokes we see every year. Here are the best ways to lower your risk:

Smoking: Quitting smoking is probably the #1 best thing a person can do for their health. Why does smoking increase the chances of a heart attack or stroke? Smoking causes reduced circulation by narrowing the blood vessels (arteries) and drastically increases the chances of a heart attack or stroke. That being said, it is very hard to quit smoking, as nicotine is incredibly addictive. Most of my patients who quit smoking tell me that they have tried to quit several times, and then one time it "just worked." So, if you are a smoker, try as many different techniques as you need to, and don't quit quitting.

High Blood Pressure: Having elevated blood pressure because of a high salt diet, inactivity, obesity, or even genetic factors. No matter why you have high blood pressure, it is important to get it under control. "Normal" resting blood pressure is Systolic (the high number) less than 120, and diastolic (the low number) less that 80. A blood pressure of 120-139 Systolic, or 80-90 Diastolic, is considered pre-hypertension. A blood pressure of 140 Systolic, or 90 Diastolic, is considered hypertension and puts you at increased risk of having a heart attack or stroke.

Diabetes: Diabetes is a very difficult disease to live with. To compound said difficulty, having diabetes more than doubles the chances of having a heart attack or stroke.

Obesity: Obesity increase the chances of having a heart attack or stroke. For most of us, staying fit is a life long struggle, but it is very important to get to, and keep, a healthy weight.

Physical Inactivity: With modern conveniences such as sit down jobs, cars, busses, TV, computers, and cell phones, it is easier than ever to have an inactive life style. Moderate exercise, such as walking 30 minutes a day, dramatically reduces the chances of having a heart attack or stroke.

High Cholesterol: Basically, what it comes down to is this: the higher our LDL, the higher our triglycerides. The lower of HDL, the more likely we are to have a heart attack or stroke.This link brings you to a "Heart Attack Risk Assessment" by the American Heart Association. With it, you can put in your numbers and find out what the chances are you will have a heart attack in the next 10 years.

In this, the first part of the series, I laid down a framework that will help us dive into the specific nuances of these new guidelines. In my next blog, we are going to explore why the experts kept getting their cholesterol guidelines "wrong."

Stay tuned and stay healthy,

Dr. Jeff M.D.



DynaMed Journal

Lancet Article

Statin Summary

CDC on Smoking

AHA Guidelines Tool

CDC on Heart Disease

CDC on Stroke



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