listen to this articleYou thought you'd reach a number that meant your “bad” cholesterol was under control. Your doctor will encourage you and give you new goals.
“Patients may say, “My LDL has reached the target level that I was told, do I want it to go lower?'' said Dr. Mehmet Aktas, director of the Rochester chapter of the American Heart Association. . “My answer to them is that our bodies are changing. Things are changing based on our age, diet, and other variables to improve outcomes and reduce heart disease and The goals we want to achieve to reduce strokes may also change.”
The same goes for science.
“There's now evidence that being a little more aggressive in lowering your LDL may actually be beneficial,” said Dr. Schmidt, a cardiologist and arrhythmia specialist at Strong Memorial Hospital at the University of Rochester Medical Center. It’s also home, Aktas says.
“In years past, an LDL cholesterol of 130 might have been considered good,” he says.
However, studies have shown that the risk is further reduced at level 100. And that number continues to decline.
“More recently, there is evidence that having an LDL below 70 is beneficial for patients who already have heart disease,” he said. “This is what medicine really is: We learn over time and challenge the status quo.”
Cardiologists and primary care providers have found themselves explaining why the goalposts have moved and explaining to people the need for a healthy lifestyle, regardless of age or medication needs.
“Cardiovascular disease is the number one killer,” says Dr. Gaurav Sharma, who runs the lipid clinic at Sands Constellation Heart Institute at Rochester Regional Health Center. “Therefore, it is our duty to prevent it and reduce the morbidity and mortality caused by it.”
“I tell my patients that there can potentially be a variety of disease processes. In my opinion, this is the preferred method at this point because it can be treated and prevented.” Masu.”
In 2018, the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines updated their guidelines on cholesterol management.
The first recommendation is to emphasize a heart-healthy lifestyle for everyone, regardless of age or medication needs.
Sharma explained that special recommendations were made for people between the ages of 40 and 75, based on their current LDL levels and the presence of diabetes or other risk factors. In some patients, he used an LDL of 70 mg/dL as a threshold for using drugs in addition to statins.
And in 2022, the American College of Cardiology issued even stricter recommendations for people who have already had a heart attack or stroke.
The ACC has also started targeting people who have never had a cardiovascular event, but the goal is to calculate age, gender, blood pressure, and It was based on an assessment that took cholesterol into account. For people whose risk is less than 5%, it is recommended to focus on diet and lifestyle, Sharma said.
Cholesterol management and risk reduction focuses on LDL, a low-density lipoprotein that can build up in your arteries and increase your risk of heart attack and stroke. “That's the most important contributing factor to plaque development,” Sharma says.
The approach to controlling cholesterol starts with your lifestyle, whether you've had a heart attack or stroke or are practicing primary prevention to avoid such events in the first place. “It's been pretty explicit in all the guidelines since I was in training,” he said.
Colleen O'Brien, a registered dietitian and nutritionist at the Anthony L. Jordan Health Center, focuses on what people can enjoy to be healthy, not what they can't eat. .
“It will be helpful,” she said.
Her recommendations are made in the context of family and culture.
“That's something I talk to people about a lot. I have to think about what they're willing to do, what they feel comfortable with. Think about what they've been eating for 30 years. And it doesn’t feel like it’s going to change their lives forever.”
O'Brien said she suggests using healthier oils, reducing portion sizes, increasing vegetables and trying whole grains like brown rice instead of white rice.
“I have certainly seen people in my office cry because they thought they had to give up something or change something, especially if they were newly diagnosed with diabetes. That can be very difficult. Food is also an emotional connection for many people. That's something we can solve together.”
O'Brien said she believes in the power of small changes. “When I work with patients, I want them to leave feeling satisfied with the decisions we made together.”
“If I just give them a nutritional prescription and they don't accept it, I haven't really helped them.”
Dr. Robert Block leads the clinical lipidology program at UR Medicine Cardiac Care. While he prescribes medications, he also advocates lifestyle changes for overall effectiveness.
“As well as reducing the risk of heart attack, stroke and lower extremity vascular disease, we know it has many other benefits.”
He cited reduced risk of diabetes, improved sleep and improved overall quality of life. “Losing 5 to 10 pounds can cause changes in blood pressure.”
If lifestyle changes are not enough or if you are at high risk of heart attack or stroke, drug therapy may be considered.
Block said patients can be hesitant to try drugs for several reasons, including misinformation from social media and other unreliable sources. She said the updated guidelines also provide a way for providers to broach the topic and have productive conversations.
Block also said the new drugs offer cardiologists and patients more options.
“If one drug, such as a statin, isn’t working for you, or you can’t tolerate the dose, or you can’t tolerate the statin, there are other drug options that can be very helpful in addition to lowering your cholesterol.” It also lowers your risk of heart attack and stroke.”
Even if he writes a prescription, Block will give advice on nutrition and activity. “It's a combination, and that's how many of us in this field have been doing it for many years.”
Patti Singer is a freelance writer living in Rochester. To contact her, [email protected].
