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Cholesterol: A Whole New Ballgame
The new cholesterol guidelines are a big deal within the medical field! Listen to Dr. Jones explain what changes have been made as of November of 2013.
Know your ten year Cardiovascular Risk, use the cholesterol algorithm tool if you are between the ages of 40 to 79.
(Once on the American Heat Association page, download VC Risk Calculator to use the cholesterol tool.)
LDL- Low density lipoprotein (bad cholesterol)
HDL- High density lipoprotien (Good cholesterol)
TIA- Transient Ischemic Attack
Statins-Class of drugs used to lower cholesterol levels
Teera Wilkins: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Teera Wilkins with Occupational Health Clinic. I have Dr. Jill Jones, an Assistant Professor in Internal Medicine who practices Primary Care General Medicine here at Vanderbilt to explain the new cholesterol guidelines released in November of 2013. Hi Dr. Jones.
Teera Wilkins: When comparing the old with the new, how are the new guidelines for treatment of cholesterol different than a previous approach?
Dr. Jill Jones: The new guidelines that came out in November are a step away from the previous recommendations. So, the previous recommendations had us targeting cholesterol levels based on a patient’s risk, and we would have goals. So, if a person was at high cardiovascular risk, we had a certain goal that we were aiming for their LDL. What the new guidelines have done is they are actually asking us to step back and take a look at who the patient is and what their overall cardiovascular risk is, and then, once we know what their cardiovascular risk is, we make a decision about whether or not they need high intensity treatment with cholesterol medicines, moderate intensity treatment, and then lesser degrees of either non-pharmacologic non-drug treatments or low intensity treatments.
Teera Wilkins: Why is that the American College of Cardiology and the American Heart Association, why did they feel the need to use the new approach?
Dr. Jill Jones: New data develops over the years and we learn more, and it ends up that the previous approach did not have a great data behind it, and this approach is actually very data driven. We are using cholesterol medicines in the people who need them and who benefit the most. So, the new guidelines are truly designed to be practical, straight forward, and perhaps more data driven and more appropriate. They have given us a tool to use that is easy for both patients as well as doctors to use that we can know what any individual’s heart risk is over the next 10 years.
Teera Wilkins: How do we know that this risk tool is a good one?
Dr. Jill Jones: The risk assessment tool was developed by experts, and it incorporates more information than what we have had in previous tools. It includes information on gender, It includes information on race. It is just giving us a little bit more of a full picture of an individual’s overall risk. Now, it is not perfect. There is no computer algorithm that gives us perfect numbers, but it gives us a good ballpark.
Teera Wilkins: Before going straight to prescribed medications, is there a protocol to first try diet and exercise?
Dr. Jill Jones: This is a complicated question; in that, there are some patients who need cholesterol medicines. And they really need them. And these are people who have already known coronary artery disease, previous strokes, peripheral vascular disease, a prior TIA. Those patients are very high risk for another cardiovascular event, and they need to be on a cholesterol medicine. They also will benefit from lifestyle changes that include healthy diet and exercise. So, some groups like them, we would not necessarily step back and say, “Hey, let’s try diet and exercise.” We would do diet, exercise, and statin. There are two other groups that there is a push for us to use cholesterol medicines fairly aggressively, and those are people who have very high LDL cholesterols greater than 190. The patients with diabetes who have LDLs that are greater than 90 and who are between the ages of 40 and 75 are also considered a very high-risk group. So, for all of those people we’re leaning toward statins with diet and exercise.
Teera Wilkins: Okay.
Dr. Jill Jones: But there is a fourth group. So, the fourth group that we have strong recommendations on to consider statins in are healthy people between the ages of 40 and 75 who when you do the risk calculator that includes their cholesterol, their total cholesterol, and their HDL numbers, if their heart risk comes above 7.5%, these are people who are really supposed to be considering a statin, and I think this is a group where after conversation with a physician you could make an argument to see if healthy diet and exercise was able to impact their risk and their lipid panel that would be a reasonable option with continued assessment.
Teera Wilkins: Since providers no longer use cholesterol levels, how will they know if the medication has worked or will work to lower your risk?
Dr. Jill Jones: It ends up that the guidelines actually do guide physicians to follow lipid panels at anywhere between 4 and 12 weeks after statins are begun, but we are not so much looking to move someone’s cholesterol below a certain level. We are actually going to use that information to make sure that a patient is taking their medicine and taking it reliably.; So, I do not want people to think that they are not going to get their blood drawn. They are still going to need to have their blood drawn, but we are going to be looking at things slightly differently.
Teera Wilkins: Thank you Dr. Jones for taking the time to shed some light on the reshaping of treatment for cholesterol.
Dr. Jill Jones: You’re welcome.
Teera Wilkins: Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have any story suggestions, please email us at firstname.lastname@example.org or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu.
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