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Those at very high risk, with recurrent cardiovascular events (heart attacks, strokes, peripheral artery disease) should aim for less than 55 mg\/dL\u00a0\u2014 down from the 70 mg\/dL the previous guidelines recommended.<\/p>\n
Guidance for children<\/p>\n
The guidelines also more explicitly state that children can start getting screened for LDL cholesterol at age 9 to 11.\u00a0<\/p>\n
New risk calculator<\/p>\n
Both sets of updated guidelines include a new risk calculator, \u201cPREVENT\u201d (Predicting Risk of cardiovascular disease Events) that predicts an individual\u2019s risk for developing heart disease and heart failure by taking into account age, sex, BMI, family history, cholesterol levels, blood pressure, diabetes, kidney function, ZIP code and other factors.<\/p>\n
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The calculator includes more contemporary, accurate and inclusive data than prior ones, measures risk over a longer period of time (10 years and 30 years, as opposed to 10 years only), and is designed to be used starting at age 30 (instead of 40).\u00a0<\/p>\n
This reflects one of the main themes of the new guidelines: to encourage people to think about their cholesterol earlier and throughout their lifetime, not just at certain points, said Dr. Ramzi Dudum, a UCSF cardiologist.<\/p>\n
\u201cThat\u2019s not so much a change, but an updating of the reality that (plaque formation) isn\u2019t an overnight process,\u201d he said. \u201cIt develops over time.\u201d<\/p>\n
Lipoprotein (a) testing<\/p>\n
The latest guidelines also say people should get their lipoprotein (a) tested at least once in their lifetime\u00a0\u2014 in more explicit language than previous guidelines did. Lipoprotein (a) is a type of cholesterol that\u2019s mostly determined by genetics, and doesn\u2019t change with diet or lifestyle. A high level is associated with increased risk of stroke, coronary disease and aortic stenosis. It is determined by a blood test.<\/p>\n
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What do the new blood pressure guidelines say?<\/p>\n
New lower targets<\/p>\n
The blood pressure guidelines set lower targets than before, encouraging most adults to strive for a blood pressure of 120\/80 or less\u00a0\u2014 lower than the 130\/80 that had been considered the norm in the past.<\/p>\n
\u201cLower is better, so that\u2019s the most important takeaway,\u201d said Dr. Joshua Knowles, an associate professor of cardiovascular medicine at Stanford. \u201cAnd a normal blood pressure is lower than what we used to consider.\u201d<\/p>\n
That means many more people will qualify as having uncontrolled blood pressure, said Dr. Surabhi Atreja, an associate professor of cardiology at UC Davis Health and director of the UC Davis Resistant Hypertension Clinic.\u00a0\u00a0<\/p>\n
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The updated guidelines recommend more aggressive, early and immediate treatment for high blood pressure. For example, those with a blood pressure of 140\/90 should start right away on a two-medication combination therapy. In the past, they would have started with one medication initially and added a second later. Those with a blood pressure of 130\/80, if they have other risk factors, should be treated aggressively.\u00a0<\/p>\n
\u201cThe main emphasis is diet, exercise and lifestyle modifications but if it\u2019s not controlled, then starting medications a little earlier than how we used to eight or 10 years ago,\u201d Atreja said.\u00a0\u00a0<\/p>\n
GLP-1 guidance<\/p>\n
Also, for the first time, the guidelines factor in GLP-1 medications, which include weight loss drugs like Ozempic that are much more widely used today than they were several years ago. The guidelines recommend that people with high blood pressure who are also overweight consider seeking a prescription for GLP-1.<\/p>\n
Lifestyle modifications<\/p>\n
The guidelines emphasize lifestyle modifications like yoga and meditation for reducing stress, and salt substitutes like products that contain 25% potassium chloride and 75% sodium chloride. They are also stricter on alcohol consumption than before, recommending abstinence as opposed to the one-drink limit for women and two-drink limit for men that was in previous guidelines.\u00a0<\/p>\n
Why are the new guidelines important?<\/p>\n
High blood pressure and high cholesterol are two of the most common\u00a0\u2014 and mostly preventable\u00a0\u2014 chronic diseases in the U.S., affecting nearly half of adults. They are major contributors to heart attacks, strokes and heart disease.\u00a0<\/p>\n
While the prevalence of heart attacks and strokes at the population level is declining\u00a0\u2014 thanks to better medications and public awareness of risk factors\u00a0\u2014 the incidence of other forms of cardiovascular disease, like heart failure and death from heart failure, are on the rise, said Dr. Ankeet Bhatt, a cardiologist at Kaiser Permanente in San Francisco.\u00a0<\/p>\n
\u201cThere\u2019s some promising news, but a lot more to do,\u201d he said.\u00a0<\/p>\n
The guidelines are meant to help doctors and patients monitor their health and act earlier to prevent problems.\u00a0<\/p>\n
Atherosclerosis, the hardening of arteries that leads to heart disease, can start earlier in life than many people realize\u00a0\u2014 in the teens. It progresses over time depending on genetics, blood pressure, cholesterol and whether you smoke or have diabetes.\u00a0<\/p>\n
\u201cThe point of these guidelines is to arrest this disease if we intervene earlier,\u201d Knowles said. \u201cAn ounce of prevention is worth a pound of cure. If we can start people at high risk over their lifetime earlier, we can prevent a lot of disease.\u201d<\/p>\n
What\u2019s driving the new guidelines?<\/p>\n
Professional medical associations update their guidelines periodically to reflect the most recent data and therapies. There are now newer and better medications to lower cholesterol and blood pressure, and more recent data showing that lower is better.\u00a0<\/p>\n
\u201cWe\u2019re kind of in a golden age of treatments for lipid-lowering therapies,\u201d Knowles said.\u00a0<\/p>\n
Just 15 years ago, doctors were limited to one class of medications, statins, he said. Since then, there have been effective trials on other types of cholesterol-lowering drugs, including injectables.<\/p>\n
\u201cThe trials done to get approval for those drugs were very large and very powerful,\u201d Knowles said. \u201cWhat they allowed us to see is that achieving lower LDL cholesterol levels has a remarkable benefit on reducing risk. We now have the evidence to support lower targets than we did previously.\u201d<\/p>\n
Similarly, the new blood pressure targets are a result of recent findings supporting the benefits of lower blood pressure. Previously, there was some concern that 120\/80 may be too low for older adults, but recent trials have found that this level is safe\u00a0\u2014 and that stricter blood pressure control can help reduce dementia risk, Atreja said.\u00a0\u00a0<\/p>\n
What should I as a patient do?<\/p>\n
Focus on the basics: Diet, exercise and medications if needed<\/p>\n
\u201cModerate exercise, at least 30 minutes a day, five days a week, can durably decrease blood pressure,\u201d Bhatt said. \u201cA healthy diet and watching your glycemic index can lower blood cholesterol. In patients who have persistent elevations in blood cholesterol or blood pressure, there are effective therapies that can reduce this.\u201d<\/p>\n
Moderate exercise generally means you\u2019re moving rigorously enough to get your heart rate up and feel like you can\u2019t have a conversation with someone, he said.\u00a0<\/p>\n
Consider getting a lipoprotein (a) test\u00a0<\/p>\n
\u201cWhile we don\u2019t yet have specific therapies to lower lipoprotein (a), we know patients with high lipoprotein (a) benefit from control of other risk factors,\u201d Knowles said. \u201cThat\u2019s the rationale for measuring that.\u201d\u00a0<\/p>\n
Lipoprotein (a) is not currently part of the standard lipid panel. Only an estimated 2% of the population has had their lipoprotein (a) tested because it was not previously recommended, Knowles said.\u00a0<\/p>\n
\u201cNow that it\u2019s part of the guidelines, it\u2019ll be easier to get it measured and will become part of routine care, hopefully,\u201d he said.\u00a0<\/p>\n
Check your lifetime risk of heart disease<\/p>\n
You can use the new PREVENT risk calculator<\/a> to assess your heart disease risk.<\/p>\n\u201cThat is the starting point for the discussion with your doctor about what you need to do next,\u201d Knowles said.\u00a0<\/p>\n
Consider a coronary artery calcium, or\u00a0CAC,\u00a0test<\/p>\n
The CAC test is a scan to check for calcium deposits in the arteries\u00a0\u2014 a marker of plaque buildup and a sign that the process of heart disease may have started. The test is not new, but the new guidelines recommend it more strongly than previous guidelines did, Atreja said. A calcium score can be helpful if, say, your cholesterol level is normal but you have calcium in the arteries\u00a0\u2014 that could indicate you may benefit from lipid-lowering treatment.<\/p>\n","protected":false},"excerpt":{"rendered":"New guidelines encourage Americans to aim for lower blood pressure and cholesterol readings \u2014 and start monitoring earlier…\n","protected":false},"author":2,"featured_media":566440,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253,78759],"class_list":{"0":"post-566439","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-us-and-world"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/566439","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=566439"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/566439\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/566440"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=566439"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=566439"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=566439"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}