NEW YORK (CBSNewYork) — There are new guidelines for treating and preventing heart disease.
The American Heart Association has revised its recommendations for who needs to take cholesterol-lowering medications.
As CBS2’s Dr. Max Gomez reported Monday, it’s now much more individualized.
Yes, it used to be that taking cholesterol-lowering medication was based on your blood levels. Five years ago, the AHA moved to using a formula that took into account age, blood pressure, family history and more.
It was confusing. These new guidelines try to simplify the decision.
Cardiovascular disease is the number one cause of death in the United States. In fact, 1 in 3 adults will die from it.
But heart disease has been declining for years and many doctors believe that’s due in part to the widespread use of statins to reduce cholesterol levels. Joyce Enright has been taking them for seven years.
“I just couldn’t get it under control by myself, so it was time,” said Enright, 64.
Joyce’s risk factors made the decision to take statins pretty clear, but previous formulas for determining who needs medication to lower their cholesterol tended to overestimate heart disease and stroke risk in some populations and underestimate them in others.
The new guidelines seek to fine-tune the medical decision-making process.
“Instead of looking at numbers and tenure risk, which we still re going to do, these are tailored to the person sitting in front of the doctor. That’s the biggest difference,” said Dr. Suzanne Steinbaum of Mount Sinai Hospital.
In other words, Dr. Steinbaum said, it’s not as simple as your cholesterol number. Other factors to take into account include previous cardiovascular disease or stroke, family history, diabetes, smoking, obesity, physical activity and more.
If treatment is needed, the first choice remains a statin such as Lipitor or Crestor, which are sold as generics for a dime a day. If the statins don’t lower cholesterol enough, other medications should be considered, including the new and very expensive drugs called PCSK9 inhibitors.
The harder decision is for patients who don’t have evidence of heart disease. It may be unclear whether they need medications. In that case, a calcium scan of the heart could be the tiebreaker.
“That looks for calcification of the arteries, and once we have that then your risk of heart disease goes up and then your would mostly likely want to prescribe a medication,” Dr. Steinbaum said.
The idea here is that one size, meaning your cholesterol number, does not fit all. Some people with seemingly normal numbers may still need medications because they have other risk factors. Again, personalized decision making.
The goal though is to prevent or lower your risk of heart disease rather than wait for angina, heart attack or stroke to start treatment.