Cholesterol Guidelines: Calculating Your Risk for Heart Disease

When you see your primary care provider for your annual physical, you get your blood tested to “know your numbers.” Included in these numbers are the “good” cholesterol, or high-density lipoprotein (HDL), and the “bad” cholesterol, or low-density lipoprotein (LDL). Cholesterol levels are monitored because too much of the “bad” kind is a main risk factor for atherosclerotic cardiovascular disease, or ASCVD, caused by the buildup of cholesterol and fatty plaque in artery walls. Unlike risk factors that are out of your control—age, ethnicity, gender—you can improve your cholesterol and therefore your risk for ASCVD with lifestyle changes and medication, if indicated.

In the past, healthcare providers looked closely at a patient’s total cholesterol and LDL. While we still monitor these numbers, in late 2018, the American Heart Association and the American College of Cardiology came out with new guidelines to calculate a person’s risk for ASCVD.

These newer recommendations suggest using a calculator that includes other factors in addition to cholesterol numbers to better evaluate risk. The calculator is used in patients 40–75 and looks at age, ethnicity, gender, blood pressure, cholesterol (total, HDL and LDL), history of diabetes, history of smoking and certain medications they may take (blood pressure and cholesterol medications, aspirin). With this information, we get an estimate for your 10-year risk of ASCVD.

When risk is calculated, we can then decide what treatment would be most appropriate.

• Risk of 5–7.5%: Consider statin therapy (medications that help lower cholesterol), but encourage lifestyle changes to help risk modification.

• Risk of 7.5–20%: Initiate a moderate-intensity statin to decrease risk.

• Risk of more than 20%: Initiate high-intensity statin therapy, with a goal of reducing LDL by more than 50%.

There are times when using this calculator isn’t necessary, such as when a patient has a history of cardiovascular disease, a high LDL (more than 190) or if the patient has diabetes, as those diagnoses alone warrant being on a statin medication. Also, the calculator is not used for those over the age of 75, as the benefits of taking statin medication in this age group have not been thoroughly studied; individual clinical assessment and risk discussion with your provider is advised.

In addition to knowing your risk, incorporate heart-healthy lifestyle elements into your routine, including regular exercise and following a plant-based or Mediterranean-like diet. These diets are shown to be most beneficial in regards to cholesterol as they are high in vegetables, fruits, nuts, whole grains and lean vegetable or animal protein. Diets high in sugar, low-calorie sweeteners, high-carb diets, refined grains, trans or saturated fats, red or processed meats have been associated with a higher risk of dying from heart disease.

Talk to your healthcare provider at your next appointment about risk assessment and to create your own personalized preventive care plan.