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There’s much that’s familiar in the new American Heart Association guidelines to help clinicians manage cholesterol, the waxy, fatlike substance that can build up in arteries and cause heart attack and stroke. For one thing, they stress the power of a healthy lifestyle — plenty of exercise and leafy greens, absolutely no smoking — to control LDL (bad) cholesterol.
While HDL (good) cholesterol doesn't get much play, the growing trend in a “personalized” cholesterol approach does. In a nutshell, not all LDL numbers reflect the same risk of a dangerous blocked or hardened artery: Clinicians are encouraged to factor in risks such as high blood pressure, diabetes, smoking or a family history of heart disease in deciding which patients should be prescribed statins to bring down their LDL number. (The guidelines also highlight a few risk factors you might not have heard of: being South Asian, or, if you’re a woman, hitting menopause early or having had preeclampsia while pregnant.)
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One of the biggest updates? The more aggressive use of statins is recommended, as well as the more extensive use of a newer class of drugs known as PCSK9 inhibitors, to more tightly control bad cholesterol for those with established cardiovascular disease.