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What do the new cholesterol guidelines mean? A cardiologist breaks it down

New cholesterol guidelines released late last year go beyond “good” and “bad” cholesterol to individualize heart care.
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For years, the American College of Cardiology (ACC) and the American Heart Association (AHA)  have maintained a set of cholesterol guidelines that are used by doctors—and the public—to measure heart health.

In November 2018, the two organizations—working in tandem with 10 other scientific organizations—updated those guidelines. We asked University of Minnesota Health Cardiologist Daniel Duprez, MD, PhD, a cardiovascular disease expert, to help us dig into these changes and understand what they mean for people concerned about their heart health.

Understanding cholesterol

Before we get to the guideline changes, let’s first briefly talk about cholesterol:

Cholesterol, which circulates in your blood, plays an important role in the body. It is used to build and rebuild the membranes—or walls—of every cell in the body. Cholesterol is also necessary to make steroid hormones, vitamin D and is crucial for brain health.

We couldn’t live without it. There are several subtypes of cholesterol, but they fall into several broad categories. High-density lipoprotein (HDL) is known as “good” cholesterol, and low-density lipoprotein (LDL), which is known as “bad” cholesterol.

University of Minnesota Health Heart Care experts provide tailored, holistic care for people with high cholesterol or other lipid disorders. Learn more about our care.

Having bad cholesterol that is too high, good cholesterol that is too low, or both, is an important risk factor for cardiovascular disease, particularly a condition called atherosclerosis. Atherosclerosis is the buildup of fatty plaques and cholesterol in the walls of arteries, which can lead to heart attack, stroke, peripheral artery disease and other serious health problems.

Many factors can affect your heart health and contribute to the development of high cholesterol. In fact, better recognition of that fact is one of the most important changes to the ACC/AHA guidelines, said Duprez, who provides care for patients with lipid disorders through University of Minnesota Health Heart Care and the University of Minnesota Health Rasmussen Center for Cardiovascular Disease Prevention.

“A person’s risk for cardiovascular disease is determined by family history, genetic predisposition, ethnicity and other medical conditions,” Duprez said. “Lifestyle factors like high fatty diet, high sugar intake, lack of exercise and tobacco use are also important cardiovascular risk factors. Using these updated guidelines can help us tailor our care for each person.”

What are the changes?

Some highlights of the new ACC/AHA guidelines include:

  • A broader definition of risk factors that increase the likelihood of cardiovascular disease, to include:
    • Family history of early heart disease
    • High bad cholesterol and/or triglyceride numbers that haven’t gone down with lifestyle changes
    • Certain medical conditions, including metabolic syndrome; chronic kidney disease; a history of preeclampsia or premature menopause; or chronic inflammatory disorders such as rheumatoid arthritis, psoriasis, or HIV
    • High-risk ethnic groups
    • An emphasis on healthy lifestyle changes throughout life and attention to cholesterol levels as early as age 20
    • New targets for bad cholesterol (LDL) and cholesterol-lowering medication recommendations (statin therapy) for people with atherosclerotic cardiovascular disease
    • New targets and cholesterol-lowering medication recommendations (statin therapy) for people with very high cholesterol or diabetes

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What does this mean for people concerned about their heart health?

In order to get a clear picture of your cardiovascular disease risk, Duprez recommends the following steps:

  • Gather your family history of heart disease and find out if anyone in your family had premature heart disease (earlier than age 55 for men and earlier than age 60 for women)
  • Take that information to your primary care physician, and take action. “Get your cholesterol tested at your annual physical with some simple lab work,” Duprez said. “That is the best way to get a reliable result.”
  • Look for early markers of disease, such as high bad cholesterol, and focus on a healthy diet and exercise to improve cholesterol numbers over time.
  • If those nutrition or lifestyle changes are not working, or are not helping you reach your lipid goals, consider additional monitoring or a cholesterol-lowering medicine, such as a statin, to reduce risk of cardiovascular disease.
  • Pay attention to your triglyceride levels. Triglycerides are another type of fat in the blood and an under-recognized risk factor for heart and vascular health.

“Most of these guidelines focus on age 40 to 75, because that is when atherosclerosis often becomes problematic. But you don’t need to wait until 40—start to have your lipids checked at age 20, because atherosclerosis build-up can begin much earlier,” Duprez said.

The University of Minnesota Health Rasmussen Center for Cardiovascular Disease Prevention takes a tailored, holistic approach to preventing cardiovascular disease. Learn more about our care.


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