Health and Me

Rachel V Thomas

AHA’s New Dyslipidemia Guidelines Stress Early Screening, Lifestyle Management

The American Heart Association (AHA), along with the American College of Cardiology (ACC), today released new guidelines for managing dyslipidemia.

Dyslipidemia can be defined as abnormal levels of one or more types of lipids or lipoproteins in the blood, including cholesterol and triglycerides.

The new guidelines, jointly published in JACC, the flagship journal of ACC, and Circulation, the flagship journal of the AHA, emphasize the need to reduce cardiovascular risk by starting to screen early. It also calls for making lifestyle changes with a proper diet, weight control with exercise, to curb the risk of atherosclerotic cardiovascular disease (ASCVD).

ASCVD is caused by the buildup of fatty deposits in the arteries and is the leading cause of death globally.

The guidelines replace the 2018 Guideline on the Management of Blood Cholesterol and offer a comprehensive “one-stop shop”.

Instead of the usual focus on just bad cholesterol, it addresses the need to evaluate, manage, and monitor all dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a) (Lp[a]).

“While we want to try to optimize healthy lifestyle habits as the first step to lower cholesterol, we realize that if lipid numbers aren’t within the desirable range after a period of lifestyle optimization, we should consider adding lipid-lowering medication earlier than we would have considered 10 years ago,” said Roger S. Blumenthal, chair of the guideline writing committee.

“Lower [LDL-C] for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk,” he added.

Early intervention through early screening and healthy lifestyle changes, starting from childhood, is the primary focus of the guidelines. It recommends: 

<ul><li>Children (9-11 years): Cholesterol screening if never done before.</li><li>Adults (30-79 years): Evaluate 10- and 30-year ASCVD risk to determine the need for early intervention</li><li>Considering lipid-lowering therapy for young adults with -- persistent LDL of at least 160 mg/dL, strong family history of ASCVD and/or at least 10 percent 30-year risk for ASCVD</li></ul>The risk factors include:

<ul><li>Family history of heart disease</li><li>Chronic inflammatory diseases (e.g., lupus, rheumatoid arthritis)</li><li>Metabolic conditions like obesity, diabetes, or chronic kidney disease</li><li>Higher-risk ancestries, including South Asian or Filipino </li><li>Early menopause, preeclampsia, gestational diabetes</li></ul>The guidelines also emphasize healthy lifestyle changes to boost heart health. They include:

<ul><li>A healthy weight,</li><li>regular physical activity,</li><li>avoiding tobacco,</li><li>healthy sleep habits</li><li>cholesterol-lowering medications </li></ul>

The guidelines state that individuals with healthy LDL-cholesterol levels or high-density lipoprotein-cholesterol (HDL-C), “cannot ‘get out of jail free’ card”. It is important to measure other biomarkers, such as: 

<ul><li>lipoprotein(a) [Lp(a)],</li><li>apolipoprotein B (apoB),</li><li>high-sensitivity C-reactive protein (hsCRP)</li><li>elevated triglycerides </li></ul>

Further, it indicates that LDL-C should be less than 

<ul><li>100 mg/dL borderline or intermediate risk</li><li>70 mg/dL for people at high risk</li><li>55 mg/dL for people at very high risk/need secondary prevention </li></ul>3. Special considerations

<ul><li>Starting lipid-lowering therapy for people age 40 or older with chronic kidney disease (stage 3 or higher), HIV or Type 1 or Type 2 diabetes</li><li>Continuing lipid-lowering therapy in people being treated for cancer, unless contraindicated</li><li>Deferring most lipid-lowering therapies during conception, pregnancy and lactation</li></ul>

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The American Heart Association (AHA), along with the American College of Cardiology (ACC), today released new guidelines for managing dyslipidemia.Dyslipidemia can be defined as abnormal levels of one or more types of lipids or lipoproteins in the blood, including cholesterol and triglycerides.The new guidelines, jointly published in JACC, the flagship journal of ACC, and Circulation, the flagship journal of the AHA, emphasize the need to reduce cardiovascular risk by starting to screen early. It also calls for making lifestyle changes with a proper diet, weight control with exercise, to curb the risk of atherosclerotic cardiovascular disease (ASCVD). ASCVD is caused by the buildup of fatty deposits in the arteries and is the leading cause of death globally.The guidelines replace the 2018 Guideline on the Management of Blood Cholesterol and offer a comprehensive “one-stop shop”. Instead of the usual focus on just bad cholesterol, it addresses the need to evaluate, manage, and monitor all dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a) (Lp[a]).“While we want to try to optimize healthy lifestyle habits as the first step to lower cholesterol, we realize that if lipid numbers aren’t within the desirable range after a period of lifestyle optimization, we should consider adding lipid-lowering medication earlier than we would have considered 10 years ago,” said Roger S. Blumenthal, chair of the guideline writing committee. “Lower [LDL-C] for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk,” he added.What Does The Guideline Say: 1. Early ScreeningEarly intervention through early screening and healthy lifestyle changes, starting from childhood, is the primary focus of the guidelines. It recommends: Children (9-11 years): Cholesterol screening if never done before.Adults (30-79 years): Evaluate 10- and 30-year ASCVD risk to determine the need for early interventionConsidering lipid-lowering therapy for young adults with -- persistent LDL of at least 160 mg/dL, strong family history of ASCVD and/or at least 10 percent 30-year risk for ASCVDThe risk factors include: Family history of heart diseaseChronic inflammatory diseases (e.g., lupus, rheumatoid arthritis)Metabolic conditions like obesity, diabetes, or chronic kidney diseaseHigher-risk ancestries, including South Asian or Filipino Early menopause, preeclampsia, gestational diabetesThe guidelines also emphasize healthy lifestyle changes to boost heart health. They include: A healthy weight,regular physical activity,avoiding tobacco,healthy sleep habitscholesterol-lowering medications 2. LDL-C cholesterolThe guidelines state that individuals with healthy LDL-cholesterol levels or high-density lipoprotein-cholesterol (HDL-C), “cannot ‘get out of jail free’ card”. It is important to measure other biomarkers, such as: lipoprotein(a) [Lp(a)],apolipoprotein B (apoB),high-sensitivity C-reactive protein (hsCRP)elevated triglycerides Further, it indicates that LDL-C should be less than 100 mg/dL borderline or intermediate risk70 mg/dL for people at high risk55 mg/dL for people at very high risk/need secondary prevention 3. Special considerations The guidelines recommend:Starting lipid-lowering therapy for people age 40 or older with chronic kidney disease (stage 3 or higher), HIV or Type 1 or Type 2 diabetesContinuing lipid-lowering therapy in people being treated for cancer, unless contraindicatedDeferring most lipid-lowering therapies during conception, pregnancy and lactation