If the latest information on health and wellness is important to you, you will not want to miss a special live-streamed webcast, “Rethinking Cholesterol,” which will be aired on Thursday, September 24, from 12:30pm to 1:30pm Eastern time. The webcast, which is free to all viewers, is co-sponsored by Reuters, Harvard Health Publishing, the Harvard T.H. Chan School of Public Health, and Harvard Medical School.
The latest guidelines used to determine who should take a cholesterol-lowering statin to prevent heart disease appear to be more accurate and cost-efficient than the previous guidelines. That’s according to two studies led by Harvard researchers, both published in this week’s Journal of the American Medical Association. The new guidelines, published in 2013 by the American College of Cardiology and the American Heart Association, recommend a statin for men and women between the ages of 40 and 75 who have a 7.5% or higher risk of having a heart attack or stroke over the next 10 years. The JAMA studies show that the new guidelines provide a more accurate assessment of who would benefit from a statin and who wouldn’t, and are more cost-effective than the older guidelines. Statins aren’t a cure-all. Eating a healthier diet, exercising often, and not smoking will go a long way to preventing heart attack and stroke.
High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But an unanswered question remains: how low should you go? New research published online today in The New England Journal of Medicine suggests that lower is better. In a large clinical trial, participants who took a cholesterol-lowering statin plus ezetimibe, a different type of cholesterol-lowering drug, had lower levels of harmful LDL cholesterol and experienced fewer heart attacks and strokes than participants taking a statin alone. The new findings provide a strong rationale for using ezetimibe when a statin alone isn’t enough.
Every so often, a medical advance comes along that rewrites the script for treating a disease or condition. After today’s announcement of impressive results of a new type of cholesterol-lowering drug, that scenario just might happen in the next few years. The results of three clinical trials presented today at the annual meeting of the American College of Cardiology, and simultaneously published in the New England Journal of Medicine, suggest that a class of new drugs called PCSK9 inhibitors can dramatically reduce the amount of harmful LDL cholesterol circulating in the bloodstream and prevent heart attacks, strokes, and other problems related to cholesterol-clogged arteries. The drawbacks are that PCSK9 inhibitors must be given by injection every 2 to 4 weeks, may cause mental confusion or trouble paying attention, and, if approved, will likely be expensive.
Warnings against eating foods high in cholesterol, like eggs or shrimp, have been a mainstay of dietary recommendations for decades. That could change if the scientific advisory panel for the 2015 iteration of the Dietary Guidelines for Americans has its say. A summary of the committee’s December 2014 meeting says “Cholesterol is not considered a nutrient of concern for overconsumption.” Translation: You don’t need to worry about cholesterol in your food. Why not? There’s a growing consensus among nutrition scientists that cholesterol in food has little effect on the amount of cholesterol in the bloodstream. And that’s the cholesterol that matters. Doing away with the beware-cholesterol-in-food warning would simplify the art of choosing healthy foods. And it would let people enjoy foods that contain higher amounts of cholesterol, such as eggs, shrimp, and lobster, without worrying about it. A better focus is on reducing saturated fat and trans fat in the diet, which play greater roles in damaging blood vessels than dietary cholesterol.
It’s been a topsy-turvy few days in the world of heart health and disease. Last week, the American Heart Association and American College of Cardiology released new guidelines that upended previous recommendations for who should take a cholesterol-lowering statin. A few days later, two Harvard physicians challenged the accuracy of the calculator included in the guidelines, saying it would cause many people to unnecessarily take a statin. The story made headlines in The New York Times and prompted a closed-door review by the guidelines committee. The controversy over the calculator should serve to improve this tool. Adoption of the guidelines should help prevent more heart attacks, strokes, and premature deaths. It’s important to keep in mind that guidelines are just that—information to guide a decision, not to mandate it. The best approach is to talk about what’s best for you with a trusted physician.
Updated cholesterol guidelines released yesterday by the American Heart Association and American College of Cardiology aim to prevent more heart attacks and strokes than ever before. How? By increasing the number of Americans who take a cholesterol-lowering statin. The previous guidelines, published in 2002, focused mainly on “the numbers”—starting cholesterol levels and post-treatment levels. The new guidelines focus instead on an individual’s risk of having a heart attack or stroke. The higher the risk, the greater the potential benefit from a statin. A statin is now recommended for anyone who has cardiovascular disease, anyone with a very high level of harmful LDL cholesterol, anyone with diabetes between the ages of 40 and 75 years, and anyone with a greater than 7.5% chance of having a heart attack or stroke or developing other form of cardiovascular disease in the next 10 years.