Skip to content
My WebMD Sign In, Sign Up

Cholesterol & Triglycerides Health Center

Font Size

New Cholesterol Drug Guidelines: Q&A

By
WebMD Health News

Nov. 14, 2013 -- The question of the day is: Should I be on a statin?

New guidelines released Tuesday by the American Heart Association and the American College of Cardiology change the standards for who should be taking these cholesterol-lowering drugs.

As doctors follow the new guidelines, more people are expected to be put on statins.

The guidelines include new weight and lifestyle measures to lower the risk of having a heart attack and stroke. The guidelines also recommend that doctors focus on overall risks to the heart and less on cholesterol numbers.  

Three doctors give their perspectives on the guidelines.

Q: What's behind the change?

"The new focus is on risk" rather than simply a cholesterol number, says Timothy Henry, MD, director of cardiology at the Cedars-Sinai Heart Institute. "This is a plan for dealing with cardiovascular risk.''  

"It starts with knowing what our risk is and then helping to manage that risk, starting with a healthy lifestyle. It starts with exercise, losing weight [if necessary], and eating the right foods. It's also being aware of the risks."

Q: What was wrong with using cholesterol numbers, as we have in the past?

"Nothing was wrong, [it's] just a different approach or focus," Henry says. "Rather than numbers, it's moving the focus to understanding risk and with a focus on a heart-healthy lifestyle.''

Q: Who is likely to get a statin now?

Just as in the past, people diagnosed with heart disease will start taking a statin.

New to the guidelines: People with extremely high LDL, or ''bad'' cholesterol, and all middle-aged people with type 2 diabetes will be advised to take a statin.

Also, men and women 40 to 75 who have an estimated 10-year risk of heart or blood vessel problems of 7.5% or higher will be recommended a statin.

Q: How is that risk determined?

To determine that risk, doctors use a calculator that figures out the chances of having heart problems in the next 10 years.

The calculator takes into account cholesterol numbers, age, blood pressure, smoking habits, and use of blood pressure medicines. All of these things affect your chance of having heart problems.

The risk calculator does not apply if you already have heart disease.

Q: After the guidelines were released, some doctors questioned how the calculator works, saying it overestimates how many people need statins. What advice would you give to people about the calculator and how to use it?

Henry says people can still use the calculator. “No risk calculator will be perfect,” Henry says. “It provides a relative risk for the patient based on established risk factors.”

Another doctor tells patients not to use it on their own. “Having used the calculator in over 100 patients, I agree that the [need for] statin use is overestimated,” says Ravi Dave, MD, of the UCLA Medical Center in Santa Monica. “I am using the guidelines with my clinical judgment and a patient’s specific history to guide me,” he says. “These are just guidelines.”

Is This Normal? Get the Facts Fast!

Is Your Cholesterol Level Heart Healthy?
What is your LDL (low-density lipoprotein) level?

Get the latest Cholesterol Management newsletter delivered to your inbox!


or
Answer:
Desirable
0-199
Borderline
200-239
High
240+

Your level is currently

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

Start Over

Step:  of 

Today on WebMD

cholesterol lab test report
Article
Compressed heart
Article
 
Compressed heart
Article
chocolate glazed donut and avocado
SLIDESHOW
 
Heart Foods Slideshow
Slideshow
Cholesterol Fact or Fiction
Quiz
 
Food & Fitness Planner
TOOL
Attractive salad
ARTICLE
 
Heart Disease Overview Slideshow
SLIDESHOW
worst sandwich slideshow
SLIDESHOW
 
Fat Foods Fit Foods
SLIDESHOW
Bad Cholesterol
VIDEO
 

WebMD Special Sections