The American Heart Association (AHA) has released new guidelines for cholesterol testing, prevention, and treatment. We asked one of our experts — Jessica Whelan, MD, a family medicine physician at our HealthEast Clinic in Maplewood — what these guidelines mean for you.
Cholesterol is often thought of as an issue for adults, but more than 20 percent of youth ages 12 to 19 have concerning test results. The guidelines encourage a lifelong approach to heart health.
“Patients will be encouraged, more strongly than ever, to lead a healthy lifestyle from an early age to prevent complications down the road,” says Dr. Whelan. “Parents can help their kids by encouraging heart health awareness, getting annual checkups, and exercising together.”
In general, the guidelines recommend risk assessments for people over 20 who don’t have cardiovascular disease every four to six years. Monitoring for your risk factors should start well before that. In certain cases, early cholesterol testing may be recommended.
“If there is a strong family history, the guidelines suggest checking cholesterol for children as young as 2,” Dr. Whelan says.
The American Academy of Pediatrics recommends first having cholesterol tested between the ages of 9 and 11 and again between 17 and 21. Dr. Whelan says most providers do this routinely with children as they approach their teen years, but she encourages parents to ask about it.
“I always say that if patients are concerned about something, ALWAYS bring it up with your doctor to determine what steps you need to take,” says Dr. Whelan.
Cholesterol levels are found through a blood test called a lipid profile. If you’ve ever had blood drawn for a test, you've probably been asked whether you were fasting. Per the new guidelines, if you're not already taking a cholesterol-lowering drug, you can get screened regardless of how recently you’ve eaten.
The screening determines your total cholesterol level, including how much "bad" cholesterol (LDL or low-density lipoprotein) and "good" cholesterol (HDL or high-density lipoprotein) are in your body. The bad cholesterol is what builds up in your arteries. Good cholesterol actually takes excess cholesterol particles out of your blood stream and carries it back to your liver.
Triglycerides — a kind of fat your body produces from your food — are also counted in the screening.
The numbers haven't changed for what's considered high or low, but you should get to know what the numbers should be for kids of different ages.
The popular approach to treating high LDL levels has been to prescribe a statin, a medication that reduces how much cholesterol your liver produces. Medication alone, however, doesn’t address all the factors that contribute to nearly one-third of American adults having this condition.
“The new guidelines take a more global view — looking at all the different reasons why people have cholesterol issues,” says Dr. Whelan. “They suggest a more comprehensive treatment plan with details pertaining specifically to the patient, rather than prescribing a cholesterol medication for everyone.”
Providers will give more consideration to a patient’s family history, past health issues, exercise regimen, and diet when determining a course of treatment.
For example, if you have a high LDL score but no other risk factors for heart disease (such as high blood pressure, obesity, diabetes, or tobacco use), you may not be automatically prescribed cholesterol medication.
Instead, further testing might be done to better understand your heart health, such as testing to discover the amount of plaque building up in your arteries. In some cases, lifestyle changes may be all that’s needed. The food you eat contributes about 20 percent of the cholesterol in your body, so you may be encouraged to change your diet. Exercise can both raise the amount of your good cholesterol and lessen the harm caused by your bad cholesterol.
If you're already taking a statin, your doctor should review the medication’s effectiveness, may consider other medications, and put further emphasis on other approaches that can help you control your cholesterol levels. For some patients, the guidelines recommend the addition of a drug that reduces how much cholesterol your body absorbs from your food.
“An individualized plan gets developed between the provider and the patient," says Dr. Whelan, "so that both are on the same page about how to improve heart health and what would work best for them.”
Dr. Whelan and the guidelines agree on two proven cholesterol-lowering strategies for all: a healthy diet and a regular physical activity.
“In general, most of us can always eat better,” says Dr. Whelan. “I don’t usually recommend radical diets, but good food choices that are healthy options. I like a plate to be colorful with veggies, lean proteins, and fruits.”
Dr. Whelan also endorses having a good exercise regime with moderate to vigorous activity that gets your heart rate going. New federal activity guidelines recommend an hour or more of daily physical activity for children ages 6 to 17, and 150 minutes of moderate activity or 75 minutes of vigorous exercise each week for adults.
Talk with your provider about your situation.
“The best treatment is through direct communication with your provider,” Dr. Whelan says. “If we need medications, then we do. But we start with what is in the patient’s power to control. Bring your questions to have answered, and come with an open mind.”To make an appointment for a cholesterol check, schedule online with a provider at a clinic near you, or by calling855-FAIRVIEW.