Big news for those of you who are concerned about your heart health: the American College of Cardiology and the American Heart Association recently released revised cholesterol treatment guidelines that are designed to reduce the risk for heart attack and stroke. The new guidelines, which were last updated in 2004, mark the most significant change in cardiovascular disease prevention in nearly thirty years!
What is cholesterol?
In order to fully understand the new guidelines, it’s important to know a little background information about cholesterol, the waxy substance that is found mainly in the membrane of all the cells in the body. Cholesterol is also involved in the production of hormones and vitamins such as vitamin D, and helps you digest foods. Your body makes all the cholesterol it needs, and some cholesterol is also found in foods, mainly animal products. Cholesterol travels through your bloodstream in small units called lipoproteins, which are made out of both fat and protein. Weight, exercise, diet, and heredity all play a role in cholesterol levels.
There are two different types of lipoproteins that carry cholesterol throughout your body: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). High levels of LDL can result in a build-up of cholesterol in your arteries, which are the blood vessels that carry blood from your heart to your body. Eventually, LDL cholesterol can enter your blood vessel walls and begin to accumulate under the lining of your vessels, restricting blood flow. In contrast, HDLs act as cholesterol scavengers, carrying cholesterol from other parts of your body back to your liver, where it is processed and removed. Total cholesterol, LDL, and HDL are three of the many biomarkers that InsideTracker monitors, so if your levels are unhealthy, the program will provide you with tailored recommendations on how to optimize them based on the new guidelines. The InsideTracker team spent days analyzing the new guidelines, and we adjusted our databases and algorithms accordingly.
What’s new with the guidelines?
One of the important changes in these guidelines is the removal of numerical target goals for LDL and non-HDL cholesterol. Instead, doctors are now being urged to assess a patient’s risk more broadly, and prescribe statins (cholesterol lowering drugs) to patients who fall into one of four risk categories:
already have had a heart attack, stroke, or symptom of cardiovascular disease; have an LDL level of 190 or higher (which is often a result of genetics); have diabetes; or are between the ages of 40 and 79 and face a 7.5 percent risk of having a heart attack over the next 10 years (using the new risk scoring system, which takes into account smoking status, blood pressure, and cholesterol level, among other factors).The goal is to direct statin treatments to those patients who have the most to gain, and move away from using treatment targets that are less reliable in predicting the risk of heart attack. Treatment with statins reduces the risk for stroke and heart disease, but there is little data to prove the benefits of reaching specific LDL cholesterol targets. While lowering LDL remains a goal with the new guidelines, the focus is on the risk reduction achieved with the use of statins, rather than the statins’ effect on LDL. Basically, what these new guidelines are saying is that we should not only be looking at cholesterol numbers, but that physicians should also be taking into consideration other risk factors, as well as emphasizing lifestyle management (which is exactly what InsideTracker plans help you to do).
The old guidelines recommended that people keep their LDL cholesterol below 100 (or below 70 for people at higher risk for cardiovascular disease). In the past, people who had high LDL levels were often prescribed statins; after the new recommendations are implemented, more than twice as many Americans could now qualify for statin treatment. Critics of the old guidelines argued that a change was needed because the cut-and-dried numerical targets have never been tested in a clinical trial. Furthermore, a review of the evidence suggested that the guidelines could lead to under-treatment of some patients and over-treatment of others.
To put all of this into context, a high-risk patient with an LDL of 180 who reduces it to 90 with the aid of a statin will substantially reduce his or her risk of heart attack or stroke. Under the old guidelines, this patient might have been viewed as failing statin therapy because his or her LDL levels did not reach 70. However, there is no strong evidence that reducing the LDL levels by another 20 points would significantly reduce risk. Essentially, for patients who have exhausted lifestyle interventions and are considering statin therapy, the question is not whether the drug makes your cholesterol tests look better, but whether it actually lowers your risk for heart attack and stroke.
These new recommendations are not without controversy. The Lancet, a well-regarded medical journal, recently published an analysis that showed that the risk calculator overestimated the 10-year heart attack and stroke risk by 75 to 150 percent. While the new recommendations have received criticism, we do know that lifestyle modifications such as following a nutritious diet and getting regular exercise can improve your heart health.
How can InsideTracker help?
With just one small sample of your blood, the InsideTracker program shows you how your total cholesterol, LDL, and HDL levels –- as well as the levels of many other biomarkers — can be improved with simple interventions such as diet, supplementation, exercise, and training modifications. InsideTracker is able to generate uniquely personal recommendations to help you optimize your health and performance.
The InsideTracker program is especially relevant to these new cholesterol guidelines because the recommendations emphasize that lifestyle management is the foundation for any solid method of preventing heart attack. The new guidelines highlight that what’s important is decreasing LDL cholesterol while maintaining levels of HDL cholesterol. One way to do this is to replace unhealthy fats with healthy fats and replace refined carbohydrates, such as sugary foods, with unrefined carbs, such as brown rice, beans, oatmeal, bran cereal, millet, barley, and couscous. Here are some heart-healthy foods that may be helpful in lowering your LDL cholesterol:
Oatmeal – oats contain soluble fiber, which reduces LDL cholesterol by blocking the absorption of cholesterol into your bloodstream. Fish – specifically, fatty fish has high levels of omega-3 fatty acids, which have been shown to improve blood cholesterol levels. The types of fish that have the highest omega-3 content are mackerel, herring, sardines, albacore tuna, salmon, and halibut. If you don’t eat fish, foods like ground flaxseed and canola oil are also high in omega-3s. Nuts – walnuts and almonds in particular – are rich in polyunsaturated fatty acids, which work to keep your blood vessels healthy. These fats may also protect against irregular heartbeats and help lower blood pressure levels. Olive oil – olive oil contains a mix of antioxidants that can lower your LDL cholesterol, but leave your “good” HDL cholesterol levels alone. The cholesterol-lowering effect of olive oil is increased if you choose the extra-virgin variety versus plain, because it is less processed, which leaves most of the antioxidants intact.If you have high cholesterol, make sure you work with your health care provider to monitor your progress. Eating healthy fats and carbohydrates along with getting regular exercise can go a long way in helping you improve your heart health!
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