What to know about the 2018 cholesterol guidelines

In late 2018, the American College of Cardiology and American Heart Association released the 2018 cholesterol guidelines. The guidelines are an update to the 2013 guidelines and serve to provide additional information for physicians on how to treat cholesterol in patients.

For some individuals, despite a heart-healthy diet, their risk for heart disease remains elevated, and they should consider medication to lower their cholesterol. The new guidelines provide a framework for how to get the right medications to the individuals most likely to benefit from them.

Dr. Michael Miedema discusses the 2018 cholesterol guidelines

Statin therapy recommendations for individuals with certain health conditions

The guidelines recommend statin therapy in addition to a healthful lifestyle in the following cases:

  • If you already have heart disease: For individuals who remain at high risk despite statin therapy and a healthy lifestyle, additional cholesterol-lowering medications may need to be added.
  • If you have diabetes and are age 40-75.
  • If you are age 20 or older and have a very high LDL >190 (known as familial hypercholesterolemia): Talk with your doctor about taking a high-intensity statin and possibly other cholesterol medications to lower your risk. If you are a woman who may become pregnant, let your doctor know before starting cholesterol-lowering medications.

Statin therapy recommendations based on age and heart disease risk level

If you don’t have any of the above conditions (heart disease, diabetes or familial hypercholesterolemia), ask your doctor to use the risk estimator to calculate your risk for heart disease. Together, you can discuss your risk level and health history and decide if taking a statin is right for you.

Based on your age and risk level for heart disease, taking a statin may be recommended in the following cases:

  • If you are 20-39 and your lifetime risk is elevated, your LDL is 160 mg/dl or higher, or you have a family history of early heart disease. If you are a woman who may become pregnant, let your doctor know before starting cholesterol-lowering medications.
  • If you are age 40-75 and are at moderate CVD risk (between 5 and 7.5%), especially if you have additional risk factors such as a family history of early heart disease, and for women, a history of preeclampsia or early menopause.

A statin is recommended if:

  • You are age 40-75 and your 10-year risk is between 7.5-20%.
  • You are age 40-75 and your 10-year risk is >20% (full dose statin is recommended).