People who have recently had a heart attack are encouraged to reduce their low-density lipoprotein (“bad”) cholesterol (LDL-C) to even lower levels than previously recommended, according to new guidelines.
A target goal of 70 mg/dl is urged for patients who have just had a heart attack or those who already have cardiovascular disease plus diabetes; who are persistent smokers; or who have high blood pressure or other multiple risk factors.
Heart patients in need of drastic measures can use statin drugs in higher doses, or they can combine statins, which block the formation of cholesterol, with drugs that block cholesterol’s uptake by the body. Studies have shown that lives can be saved with a drastic lowering of LDL levels in people who have had recent heart attacks.
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- For very-high-risk patients, the new goal is a level of 70 mg/dl; the previous target was 100 mg/dl.
- For almost all high-risk patients with LDL levels over 100 mg/dl, the new guidelines call for drug therapy.
- For moderately high-risk patients with multiple risk factors and a 10% to 20% chance of heart attack or cardiac death within 10 years, drug therapy is indicated if LDL levels are 130 mg/dl or higher, and it is an optional consideration if LDL levels are between 100 and 129 mg/dl.
- For patients at lower to moderate risk, the guidelines are the same; low-risk patients should maintain a level of 160 mg/dl or lower, and moderate-risk patients should stay at 130 mg/dl or lower.
The new recommendations pose a significant challenge for physicians and patients. Most patients will probably not achieve levels below 70 mg/dl with standard doses of statins. The average LDL level in the U.S. is 127 mg/dl.
Although statins are generally considered safe, higher doses can increase the risks of liver problems and muscle pain.
In addition to drug therapy, patients are also encouraged to follow a diet low in saturated fat and cholesterol, to exercise, and to keep their weight under control.
Created by the National Cholesterol Education Program, the guidelines are endorsed by the American Heart Association, the American College of Cardiology, and the National Heart, Lung, and Blood Institute.
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Although the guidelines omitted mention of the panelists’ links to some of the drug companies that manufacture the statins, cardiologists expressed no doubts about the quality of research leading to the updated guidelines.