What You’ll Learn:

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• Why the cholesterol and lipid guidelines were updated.
• How the new cholesterol guidelines are different from earlier suggestions.
• What makes the new cardiovascular disease risk calculator more accurate.
• What intervention is recommended and how soon it should start.
• The identified dyslipidemia risk enhancers that impact the need for early intervention.
• How to know if you have dyslipidemia risk enhancers.

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Guidelines from organizations like the American Heart Association (AHA) and the American College of Cardiology (ACC) play a huge role in diagnosing and treating health conditions. So, when guidelines are updated it’s something that warrants attention.

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The recent lipid and lipoprotein guideline updates from the AHA, ACC and others should catch the attention of every American given that 25% of adults have elevated LDL cholesterol. But a healthy cholesterol ratio is just one factor that increases the risk of heart attack and stroke. The recently updated guidelines were issued to improve the detection of all the risk enhancers in an effort to decrease the number of cardiovascular deaths.

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Consolidated Data, Inaccurate Measurements and Earlier Intervention Motivated the Updates

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Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide. It’s a condition that is directly tied to dyslipidemia, abnormal lipid or lipoprotein levels in the blood.

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While it’s important to know what’s been updated for the lipid and lipoprotein guidelines, knowing why the updates were made is also essential. The AHA and others felt it was time for an update for several key reasons.

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Consolidated Data That’s in One Document

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There are 11 medical associations that contribute to lipid and lipoprotein guidelines. Previously, the data, documentation and recommendations were spread out making it harder to track down information. 

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The new guidelines were a collaboration among the medical associations to consolidate everything into a single document. Described as a “one-stop shop”, physicians and patients now have a single source for assessing, diagnosing and treating blood lipids.

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More Accurate Diagnostics

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Accurate measurements are vital for diagnosing ASCVD. The AHA explained that earlier calculations using the Pooled Cohort Equations that were used to measure cardiovascular risk were inaccurate. They overestimated the 10-year risk and didn’t factor in certain health metrics.

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It’s been recognized that risk measurements need to go beyond LDL and HDL cholesterol. We now know that other biomarkers provide a more accurate assessment of risk, and that is now being factored in during diagnosis.

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Earlier Intervention For At-Risk Individuals

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Something that the new guidelines make clear is that earlier intervention is needed to prevent ASCVD deaths. Part of the reason more biomarker measurements are recommended is to determine how soon lipid lowering therapies should be used to minimize cardiovascular risk.

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In an effort to fully assess whether earlier intervention is appropriate, the new guidelines recommend additional testing. In addition to cholesterol levels, blood pressure, age and weight, the AHA recommends testing Lp(a) and apoB levels as well as conducting non-contrast coronary artery calcium (CAC) scans in some cases. 

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What the New Guidelines For Cholesterol Levels Look Like

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Experts at the AHA and ACC noted that the LDL cholesterol levels that were previously recommended weren’t low enough. “Clinical trials have clearly demonstrated significant benefits for reduction in cardiovascular events when LDL-C levels are even lower than recommended in previous guidelines,” stated the vice-chair of the guideline writing committee, Pamela B. Morris, MD, FACC, FAHA.

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The new LDL cholesterol recommendations are:

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• Less than 100 mg/dL for borderline or intermediate risk 
• Less than 70 mg/dL for high risk
• Less than 55 mg/dL for very high risk 

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People in the very high risk group include those that have already experienced cardiac events. Across the board, the lower LDL cholesterol is the better. 

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New Risk Calculator

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On top of the new LDL cholesterol benchmarks, there’s also a new cardiovascular disease risk calculator called Predicting Risk of Cardiovascular Disease EVENTs (PREVENT). PREVENT promises to help clinicians more accurately gauge cardiovascular disease risk for 30-79 year olds based on the latest clinical research. 

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PREVENT equations measure both 10-year and 30-year risk for cardiovascular events. In addition to basic health metrics, lipids and lipoproteins, PREVENT includes metabolic and kidney function measurements as well. 

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Identified Dyslipidemia Risk Enhancers Everyone Should Know

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The specialists at the AHA have also expanded the list of dyslipidemia risk enhancers that can be used to gauge a person’s likelihood of developing ASCVD. The risk enhancers to watch out for include:

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• Family history of heart disease
• Chronic inflammatory conditions 
• Cardiometabolic conditions (overweight/obesity)
• Diabetes 
• Chronic kidney disease
• South Asian or Filipino ancestry (ancestral groups with an enhanced risk for atherosclerosis)
• Reproductive risk markers (early menopause, preeclampsia and gestational diabetes)
• High Lipoprotein(a)/Lp(a) levels
• Elevated apolipoprotein B (apoB) levels
• High-sensitivity C-reactive protein (hsCRP) 
• Elevated triglycerides

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At-Home Testing Can Tell You If You Have Dyslipidemia Risk Enhancers

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Some of the dyslipidemia risk enhancers are known, such as family health history and ancestry. Others can be diagnosed by a primary care physician. Then there are biomarkers that require testing.

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In the group of key risk enhancers are four biomarkers that can now be measured at-home using the advanced cardiovascular test from Choose Health. Other blood tests come up short, only measuring cholesterol levels. Well before the AHA updates, Choose Health recognized the importance of measuring Lp(a), apoB and hsCRP as well. We developed our cardiovascular test to give users the most complete picture possible of the lipids and lipoproteins that contribute to arterial plaque buildup. 

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Testing these biomarkers as well as cholesterol is so important, the new guidelines recommend testing as early as 9-11 years old. Doing so can spot potential cardiovascular disease decades before it starts, allowing parents to help their kids make lifestyle changes to lower future risk. 

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Anyone who has a higher than recommended LDL-C level or any of the dyslipidemia risk enhancers should make lifestyle adjustments that can help get levels within a healthy range. If lifestyle adjustments alone aren’t enough, the new guidelines recommend starting statin therapy right away. And if that combination doesn’t move the needle, there are other non-statin therapies that can be used. 

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With the right information, we can make headway in lowering cardiovascular disease by identifying when a problem exists much earlier and intervening quickly. Choose Health is one of the resources that people can use to measure the recommended biomarkers and track LDL cholesterol changes to determine if lifestyle changes and therapies are making a difference. 

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This article is for educational purposes only and does not constitute medical advice. Speak with a qualified clinician about your specific results and cardiovascular risk management.

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