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The low-down on new cholesterol guidelines
Drug therapy recommendations just became more aggressive for high-risk cardiac patients. Earlier this year, the National Cholesterol Education Program (NCEP) released more intensive guidelines for treating people at high-risk of heart attack and death from cardiovascular disease.

Who is at high-risk? A person who has had a prior heart attack or other risk factors. These individuals have more than a 20 percent estimated risk of heart attack or cardiac death within ten years, and include those who have:
• cardiac chest pain (or angina)
• angioplasty or bypass surgery
• obstructed blood vessels to the extremities or brain
• diabetes

The new NCEP guidelines set the goal of lowering low-density lipoprotein (LDL) cholesterol, also known as “bad cholesterol,” for patients with LDL cholesterol of 100 mg/dL or higher. An LDL of 70 mg/dL is a therapeutic option for people at very high risk of heart attack or death. The previous guidelines recommended cholesterol-lowering drugs for those with an LDL of 130 milligram per deciliter (mg/dL) or higher.

“Releasing new guidelines is an effective way to get the word out about what will affect the most people and have the greatest benefit,” says Palmetto Health Heart Hospital cardiologist Dr. Verne Prosser. “A more aggressive approach to lowering cholesterol and treating heart disease will help individuals who continue to have coronary events despite lowered or normal cholesterol values.”

The new guidelines recommend cholesterol-lowering drug therapy for high-risk patients, but it may be costly and may require high doses of medication or combination drug therapy. “Combination drug therapy is usually most effective in treating these patients, reducing coronary events by 70 to 90 percent,” says Dr. Prosser. “And a high dose of statins, or cholesterol-lowering drugs, does not work for everybody. Lowering cholesterol is just one part of the solution to restoring a patient’s heart health.”

Making lifestyle changes, such as smoking cessation, eating well, and exercising regularly, are still very important. “The critical point to remember is that each patient has a specific lipid issue needing specific, customized treatment to prevent future coronary events,” says Dr. Prosser.

High-risk people:
Reduce LDL cholesterol levels to under 100 mg/dL, with an overall goal to reach 70 mg/dL or lower.

Moderately High-risk people:
Treatment is needed if LDL levels are 130 mg/dL or higher, with an optional drug therapy if between 129-100 mg/dL.

Older people:
Lowering LDL cholesterol is an especially positive preventative measure.