By Jacqueline Howard, CNN
(CNN) — Millions more adults should consider starting cholesterol-lowering medications earlier to reduce their risk of heart attack and stroke, according to new medical guidance.
In an updated guideline released Friday, the American College of Cardiology and the American Heart Association – along with nine other medical groups – emphasize that treating high cholesterol sooner, even starting in their 30s, could significantly reduce a person’s lifetime risk of heart attack or stroke.
The 123-page guideline covers many aspects of managing cholesterol and triglycerides, but one message stands out: Don’t wait too long to act.
Statin therapy is recommended, in addition to lifestyle changes like diet and exercise, for adults as young as 30 who have an LDL cholesterol of 160 milligrams per deciliter or higher, a strong family history of premature heart disease or a high 30-year risk of developing cardiovascular disease, according to the updated guideline.
“Our standard practice has been to assess 10-year risk, and statistically that will be low for a person in their 30s. But now we see a shift to 30-year risk projections,” said Dr. Jennifer Haythe, co-director of the Women’s Heart Center at NewYork-Presbyterian/Columbia University Irving Medical Center, who was not involved in the updated guidance.
“The potential benefits of starting lipid-lowering agents in younger patients are real, as there is well-supported trial data that longer duration of reduced LDL exposure translates to less plaque accumulation.”
In the United States, “there are roughly 65 to 70 million people ages 30 to 44,” she said. “So even if some small fraction of those individuals has an LDL greater than 160, the number potentially qualifying under the new criteria – with a higher 30-year risk – could be in the millions.”
Statins, some of the most commonly prescribed types of medication, work by lowering LDL cholesterol, which can build up in the arteries over time. For adults at borderline or intermediate risk, ages 30 to 79 who have started statins, the updated guideline recommends getting their LDL cholesterol down to less than 100 milligrams per deciliter of blood to prevent a first heart attack or stroke. For those at highest risk, the goal is less than 55.
Many adults with low 10-year risk but elevated 30-year risk already meet other indications for statin therapy, Drs. Pam Morris and Roger Blumenthal, authors of the updated guideline, said in an email.
“Nevertheless, incorporating a 30-year risk criterion would potentially extend consideration of statin therapy to several million additional Americans,” they wrote. “It should be noted that the risk estimates are used to identify patients who are potentially eligible for drug therapy. Subsequent steps in decision making involve consideration of patient-specific factors and the patient’s own goals for preventive therapy.”
This new shift is happening as a mounting body of research shows that reducing lifelong exposure to plaque-causing lipids and lipoproteins is associated with better long-term cardiovascular outcomes, Morris and Blumenthal said.
The updated guideline recommends using a “more contemporary” calculator to evaluate a 30- to 79-year-old adult’s cardiovascular disease risk over 10 years and 30 years: the American Heart Association’s Predicting Risk of Cardiovascular Disease EVENTs or PREVENT online calculator.
“The PREVENT-ASCVD risk estimate does not write a prescription, but it starts a conversation between the clinician and the patient. Most clinicians would likely be thinking about treating these younger men and women more aggressively because their overall burden of measured risk factors