May 01, 2019

New cholesterol guidelines tailor risk assessment

As the understanding of cholesterol's role in health continues to evolve, so do guidelines on cholesterol management. A task force of numerous medical organizations, including the American Heart Association and the American College of Cardiology released 2018 guidelines to replace those published in 2013. The guidelines were simultaneously published in November 2018 in two major medical journals, Circulation and the Journal of the American College of Cardiology.

While the new guidelines include many changes, the biggest involve more-detailed risk assessments and calculations, and new cholesterol-lowering options for people who are at highest risk of cardiovascular disease. In addition, new recommendations are included for managing cholesterol throughout a lifetime, including during childhood.

Traditional risk factors — smoking, high blood pressure (hypertension), diabetes and high blood cholesterol — continue to be used when determining cardiovascular disease risk. At the same time, the guidelines list other factors to consider when evaluating risk. One of these is metabolic syndrome, a cluster of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together. Other newly-listed risk factors include chronic kidney disease, chronic inflammatory conditions such as rheumatoid arthritis or psoriasis, a history of premature menopause or pre-eclampsia, and high lipid biomarkers. Also noted is that coronary calcium scores could be used to decide whether a statin drug to improve cholesterol levels is appropriate for those at an elevated but not high risk of cardiovascular disease.

A coronary calcium scan — also known...