Heart experts say the change offers a comprehensive “one-stop shop” for how to best assess and treat blood lipids.
WASHINGTON — New and aggressive preventative screening guidance aims to identify and treat cholesterol risks well before it could lead to heart disease.
The new guidance was released Friday by the American Heart Association, the American College of Cardiology, and other leading medical groups. They say the change offers a comprehensive “one-stop shop” for how to best assess and treat blood lipids.
Roughly 1 in 4 U.S. adults have high levels of low-density lipoprotein cholesterol, often referred to as “bad” cholesterol. High LDLs are associated with an increased risk of heart attack and stroke.
According to the report, about 80% or more cardiovascular disease is preventable, and elevated LDL is a major part of that risk. The new guidance aims to look beyond simply testing LDLs and triglycerides.
One of the most significant changes is the adoption of a new risk calculator, called PREVENT-ASCVD, designed for adults between 30 and 79 years old. This replaces an older screening calculator. The updated risk categories classify 10-year risk as low (under 3%), borderline (3–5%), intermediate (5–10%), or high (10% or more).
That calculation can be further refined by what the guidelines call “risk enhancers,” which are factors that could accelerate earlier or more aggressive treatment.
Doctors are also encouraged to consider three additional tests to help screen for risk factors:
Selective use of a non-contrast artery calcium (CAC) scanLipoprotein (a), or LP(a)Apolipoprotein B, or apoB
The new guidelines encourage a wider use of the CAC scans, which are non-invasive and help measure calcified plaque buildup in a person’s arteries.
The screening for lipoprotein(a), or LP(a), is a one-time blood test during adulthood that identifies a genetic risk marker for heart disease. Experts say the number is genetically determined and remains relatively stable during a person’s lifetime, so it’s unlikely a second test would be needed. Elevated levels help identify inherited risks for stroke, heart attack and other cardiovascular illnesses.
The apolipoprotein B, or apoB, test helps identify residual risk for deposits on blood vessel walls.
“Having healthy LDL-cholesterol levels or high-density lipoprotein-cholesterol (HDL-C), traditionally thought of as ‘good’ cholesterol, isn’t necessarily a ‘get out of jail free’ card,” said Dr. Roger Blumenthal, the chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore. “Measuring other biomarkers can give a more complete picture of someone’s cardiovascular risk and help inform decisions about whether lipid-lowering therapy is needed sooner rather than later or if more intensive therapy is warranted.”