By Victor Acquista, MD
Integral Health Specialist
When I was in medical school in the late 1970s, the topic of blood lipids – and cholesterol in particular – was just beginning to generate a lot of research and investigation. Today our understanding of blood lipids and the role they play in diseases of atherosclerosis (coronary artery disease, strokes, aneurysms, and peripheral vascular disease) continues to evolve.
The American College of Cardiology and the American Heart Association recently issued new guidelines, reflecting this better understanding of cholesterol and updating treatment recommendations.
Here’s a brief overview of why they are important.
Background on atherosclerosis
High blood pressure, cigarette smoking, diabetes, high cholesterol, and family history remain the major risk factors for development of atherosclerosis. There are also minor risks, including obesity and sedentary lifestyle.
The more risk factors you have, the greater your chance of developing atherosclerosis –the accumulation of fatty deposits that clog arteries. Artery location affects the chances of developing a disease associated with its blockage. Deposits clogging the carotid arteries in the neck are a major risk factor for stroke. If the coronary arteries are blocked, (also called arteriosclerosis), the damage can result in blood clots, leading to myocardial infarction. The aorta is the main artery receiving blood pumped from the heart and distributing it throughout the rest of the body. Blockage often leads to an aortic aneurysm, which can rupture and cause death. When other arteries are clogged by arteriosclerosis, such as the femoral artery that circulates blood to the leg, the resulting reduced flow of blood through the artery can starve the muscles in the leg from getting oxygen carried in the blood. Painful cramping called claudication can result or even tissue death and gangrene.
The bottom line – atherosclerosis contributes to a large burden of mortality and morbidity. The good news – it is often preventable or can be mitigated with treatment.
How do we treat atherosclerosis?
The short answer to this question is through lifestyle/behavior change, medication, and certain medical procedures. High blood pressure can be effectively treated with lifestyle modification and medication. The same is true of diabetes. Smoking can be discontinued. While we cannot change our genetic makeup, certain behavioral changes can affect how our genes are expressed. Diet and exercise are the primary lifestyle modifications that can affect cholesterol and there are medications called statins – Lipitor and Crestor are just two examples – which lower cholesterol.
Angioplasty, bypass surgery, and stent placement are three types of common medical procedures utilized to treat atherosclerosis.
It is important to discuss your risk for atherosclerosis and treatment recommendations – including diet and exercise – with your doctor or health care provider.
The new cholesterol guidelines
The guidelines divide people based on risk categories and provide guidelines for each classification. In the guidelines, the terminology used is atherosclerotic cardiovascular disease (ASCVD). Other terminology related to lab tests results for the carrier proteins that transport cholesterol. These include tests as HDL or high-density lipoprotein and LDL or low-density lipoprotein.
The guidelines define four statin benefit groups:
1. Patients with any form of clinical ASCVD.
2. Patients with primary LDL-C levels of 190 mg per dL or greater.
3. Patients with diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL.
4. Patients without diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk greater than or equal to 7.5 percent.
Depending on your overall risk factor profile – calculate it at http://tools.cardiosource.org/ASCVD-Risk-Estimator/ – you may be considered for treatment using three different levels of intensity.
1. High intensity: Daily dosage lowers LDL-C by approximately greater than or equal to 50 percent on average
2. Moderate intensity: Daily dosage lowers LDL-C by approximately 30 percent to 50 percent on average
3. Low intensity: Daily dosage lowers LDL-C by less than 30 percent average
(Daily dosage differs for different specific statins needed to achieve the desired LDL-C reduction)
Your cholesterol values are more than a simple number. The results are important to understand in terms of your risk for developing serious diseases associated with atherosclerosis and what you can do to help reduce your risk of death and disability from ASCVD.
Victor Acquista MD is author of “Pathways To Health: An Integral Guidebook”. For more information on Dr. Acquista’s book, visit http://pathstohealth.info/
