By Dr. Monica Ball, MD
Recently while in clinic, I saw a pleasant woman in her 50s with a history of well-controlled diabetes. As we were discussing her medications, I asked her if she had ever been on a cholesterol lowering medication in the statin class, which includes brand names such as Lipitor, Crestor, Zocor, Pravachol, Mevacor, Livalo, and Lescol. She glanced sideways at me, confused; she replied that her previous doctor has always told her her cholesterol numbers were good.
New Guidelines for Treating High Cholesterol
The woman I saw was not alone in her confusion about her cholesterol numbers. This is because in 2013, the American College of Cardiology in conjunction with the American Heart Association released new recommendations on the treatment of cholesterol, doing away with the previous “treat to target numbers” system that both providers and patients alike could easily understand. Incorporating evidence from high quality randomized control trials, the new treatment guidelines take a more ‘patient-specific’ approach, allowing therapy to be individualized for each person. The downside to this is that the new guidelines are more difficult to understand, and doctors must use a complex mathematical equation to determine the optimal therapy (which, thankfully, they can calculate by entering a patient’s variables into a computer app).
Under these new guidelines, doctors may now recommend that many people should start a cholesterol-lowering medication who may not have been eligible before. This makes sense if you think about it – a person with a total cholesterol that is one point lower than the previous “treat to target” number probably wasn’t at lower risk for atherosclerotic disease, stroke, or heart attack than someone whose total cholesterol was one point above the “treat to target” number. Yet, the old system would have recommended the first person should have no intervention while the second person would be on medications.
Cholesterol and Stroke Risk
The reason this is important is that higher levels of low-density lipoprotein (LDL or bad cholesterol) have been shown through decades of animal and human research to be associated with higher risk of stroke, coronary heart disease, heart attack, and peripheral artery disease. As an adjunct to a heart healthy diet, regular exercise, maintenance of a healthy weight, avoidance of tobacco products, and alcohol in moderation, cholesterol lowering drugs can significantly decrease these risks and help prevent the recurrence of coronary heart disease, heart attack, and stroke.
If you think you may be at risk for stroke, speak with your medical professional about cholesterol, and do not be surprised if he or she recommends the above lifestyle changes and a cholesterol lowering drug.
About the Author
Monica Ball, MD, is a Family Medicine Physician based in Southern California. Her focus is on providing holistic treatment to under-served patient populations in order to prevent and manage chronic diseases such as stroke. In her free time, she runs marathons, reads, and is slowly learning to cook like a pro. She writes for Flint to share her knowledge and experience as a doctor with a broader audience.