The American College of Cardiology and American Heart Association along with 9 other organizations just came out with new guidelines on cardiac prevention and cholesterol. A BROWN HEART SUMMARY IS OUTLINED BELOW. Almost all of them STRONGLY REINFORCE the Brown Heart principles we have been advocating
Top 10 summary points are noted below, especially for BROWN HEARTS
- South Asians ancestry is formally recognized as a RISK ENHANCING FACTOR. Our cardiovascular risk may be underestimated by traditional calculators, so LDL lowering should be taken seriously even at younger ages.
- Specific LDL targets are back in the guidelines. The new recommendations again emphasize treating to clear LDL goals based on risk.
- LDL goals now depend on cardiovascular risk. For Brown Hearts we have already been STRONGLY recommending. The numbers 100, 70 and 55 are what we have been advocating and are reflected in the guidelines. DO YOU KNOW YOUR LDL NUMBER? In general, aim for LDL below 100 mg/dL; If diabetes, go below 70, and if heart disease go below 55
- The guidelines now emphasize 30-year risk, not just 10-year risk. This is especially important for younger adults, whose short-term risk may appear low despite high lifetime exposure to LDL.
- Supplements do not meaningfully lower LDL. Fish oil, cinnamon, turmeric, plant sterols, and red yeast rice were no better than placebo in trials, and garlic pills may even raise LDL.
- Lp(a) should be checked at least once in life. Elevated Lp(a) is an independent risk factor and may justify more aggressive LDL lowering.
- Cholesterol prevention should start early. At-risk adults should begin trying to lower LDL by around age 30 and continue throughout life.
- Screening should begin early in life. LDL testing is recommended in childhood around age 10 to detect familial hypercholesterolemia, and again around ages 18–20.
- Repeat cholesterol screening regularly. Most adults should be rechecked at least every 5 years, and more often if they have high LDL or other risk factors such as diabetes.
- Lifestyle comes first, but many patients will also need medication. Diet and exercise are the foundation, but statins and other LDL-lowering therapies are often needed to reach modern targets.
