New Guidelines for Cholesterol Levels: Should You Be Taking A Statin?

New Guidelines for Cholesterol Levels: Should You Be Taking A Statin?

The American Heart Association (AHA) and the American College of Cardiology (ACC) recently released a new set of guidelines about healthy cholesterol levels. The new guidelines also suggest ways to lower your cholesterol. One of the biggest changes in the guidelines is the way in which healthcare providers are supposed to prescribe statins, a type of medicine that helps lower cholesterol levels.

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Statins are a type of medicine that you might take to lower your cholesterol level. Cholesterol, a type of fat that is found in a natural form in the human body, serves many purposes. Everyone needs cholesterol to live. Like so many other things in your body, healthy cholesterol levels is all about having balance. There are a few types of cholesterol in the body. The main forms of cholesterol are HDL, or “good cholesterol” and LDL, or “bad cholesterol.”

LDL cholesterol is bad because too much of it can stick to the inside walls of blood vessels, forming hard substances called plaques. These plaques cause the blood vessels to become narrow, which can limit blood flow to vital organs like the heart and brain.

HDL cholesterol is good because it helps prevent these plaques from forming. Most of the choles- terol in the body is made in the liver. Statins work by preventing the liver from making cholesterol, mostly limiting the production of bad, LDL cholesterol.

With less cholesterol being made, the cells in the body work harder to get LDL out of the blood. Therefore, statins lower blood cholesterol levels by:

  • Decreasing production of cholesterol
  • Increasing the amount of cholesterol removed from the blood by the cells in your body

How Are The New Guidelines Different?

The old cholesterol guidelines  gave specific target levels for cholesterol in certain groups. For example, if you were in a high-risk group for heart disease, you were supposed to get your LDL level to 70 or less. If taking a statin did  not get you to less than 70, your doctor would have given you another medicine to try to get you there. . The problem with the old approach is that there is no proof that achieving those targets make you healthier. Lots of research has shown, however, that taking a statin, even without trying to meet cholesterol target levels, decreased your risk for heart disease. Therefore, the new guidelines focus more on who should be taking statins to decrease their overall risk for heart attacks and strokes, rather than focusing on reaching a certain cholesterol target level.

Are Statins Safe To Take If I Have Diabetes ?

Statins, like all medicines, can have side effects. The most common side effect of statins is muscle aches and pains. This condition, called “myositis” or “myopathy,” can sometimes be so severe that you need to stop taking the medicine. Statins can also cause liver damage, a condition your healthcare provider can look for with simple blood tests. For many people with diabetes, a common question is whether or not statins increase the chances for cataracts. A recent study found that people who take statins are more likely to develop cataracts, but this does not mean that statins cause cataracts. Another study found that statins, if started early, may decrease your chance of getting cataracts. While more research is needed to answer the cataract question, healthcare providers agree that in most cases, decreasing your risk for heart attack and stroke is more important than any side effects the statin medicines might have.

How To Know If You Should Take A Statin ?

If you ever have any questions about your medicines, talk to your healthcare provider at your next visit. Regarding statins, the authors of the new guidelines created a Heart Disease Risk Calculator to help you and your healthcare provider figure out if you should be taking a statin. The calculator uses answers to questions about things like age, race, gender, blood pressure, diabetes, and smoking habits to estimate your risk for having a heart attack or stroke in the next 10 years:

  • If your risk is greater than about 10 percent in the next 10 years, you should talk to your healthcare provider about taking a statin.
  • If your risk is less than 10 percent, you should start with lifestyle changes such as:
    • Increasing physical activity
    • Quitting smoking
    • Eating a healthful diet. You will get the best results by combining any medicines you take with a healthy lifestyle.

Take Home Points About The New Cholesterol Guidelines

  • Decreasing your overall risk for heart disease by taking a statin is more important than getting your cholesterol below a certain level.
  • If you have diabetes and are not already taking a statin, you might be told by your healthcare provider that you need to start taking one.
  • If you are taking several medicines to lower your cholesterol, you might be able to stop taking some of them if your healthcare provider advises you to do so.
  • The benefits of taking statins— particularly if you have diabetes— are usually far greater than any risks from the side effects they can cause.
  • The best way to decrease your risk of heart attacks and strokes is to take the medicines your healthcare provider prescribes along with making healthy lifestyle choices like increasing physical activity, not smoking, and eating more fresh fruits and vegetables.

 

By Robert Ehrman, MD

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