High cholesterol: what to do to prevent heart attack and stroke.Algorithm - La. He holds out his hand.

Thanks to the calculator that defines risk profiles, we focus on specific tests.The goal is to act without waiting for personalized attention.From America…

Important news comes from the update of the guidelines for the treatment of dyslipidemia, that is when there are abnormal levels of cholesterol (also taking into account the lipoproteins that transport it such as LDL and HDL), triglycerides and more.Thanks to the use of the PREVENT calculator (Cardiovascular Disease Risk Prediction, a model that will also be possible to be EVENTS) therapies to reduce the dangers of heart attack and stroke. The experts at the American College of Cardiology and the American Heart Association are proposing these and other innovations.

Atherosclerosis under the lens is coronary heart disease;Fat accumulation in the arteries is a leading cause of death worldwide.The article was co-published by JACC (Journal of the American College of Cardiology) and Circulation.early lifestyle intervention;weight control;choosing regular physical activity;In addition to getting enough rest and avoiding smoking,The importance of taking cholesterol-lowering medications when prescribed by a doctor is emphasized, mainly because of the need to achieve adjusted LDL cholesterol levels.Based on personal risk.

The score points the way.

The PREVENT algorithm estimates the risk of heart attack or stroke in adults aged 30 to 79 years without known atherosclerotic disease or in any setting between 70 and 189 mg/dL of bad cholesterol and guided therapy for lipids.The modified risk categories of the PREVENT-ASCVD equation show the lowest 10-year risk (3%), borderline (3% to 5%); Classified as moderate (5% to 10%) and high (10% or more). These risk categories guide treatment decisions, including the recommended intensity of hypolipidemic therapy, which may be dependent on other measures, and possible therapies that can initiate therapystatin

According to expert indications, if lifestyle habits and statin therapy, which is the cornerstone of lipid reduction and cardiovascular risk, do not lead to the desired reduction in bad cholesterol values, the addition of other methods is recommended: subcutaneous therapy in anti-PCSK9, starting with ezetimibe and/or bempedoic acid.All this, while other drugs are gaining ground."Compared to these US indications, European guidelines have long emphasized very low LDL cholesterol targets in high and very high-risk subjects and more intensive lipid-lowering strategies - comments Leonardo De Luca, Director of Cardiology at the Foundation IRCCS Policlinico San Matteo di Pao.

Chi corre rischi specifici

Thanks to the report, in addition to blood lipid values, other aspects that seem important for individual treatment can also be taken into account.They range from a family history of heart disease to chronic inflammatory conditions (such as lupus or rheumatoid arthritis) to cardiometabolic conditions such as overweight/obesity, diabetes or chronic kidney disease, to conditions that put women at risk, including pre-menopause, pre-eclampsia and gestational diabetes.Only this: in some cases, other tests can be used to better define the risk profile: remember to measure lipoprotein (a) or Lp (a), apolipoprotein B (apoB), high-sensitivity C-reactive protein (hsCRP) and triglycerides.Finally, the new guidelines will lead to more trials to select even more "hard" treatments to lower bad cholesterol in certain conditions.

This is the case of CT to study the number of arteries (which is recommended for men aged 40 and over and for women aged 45 and over who have had heart disease or stroke for a limited or average of 10 years).But it should also be remembered that once in a lifetime it is necessary to measure Lp(a) and Apolipoprotein B, which helps treat people with cardio-nephro-metabolic syndrome, type 2 disease, hypertriglyceridemia or known cardiovascular disease who have reached their LDL cholesterol goals.

Act quickly

The guidelines also modify LDL-cholesterol values: to prevent a first heart attack or stroke, the goal of this parameter should be less than 100 mg per deciliter for people at borderline risk (hence the "margin of normality") or at intermediate and high risk.For individuals at very high risk of cardiovascular events, the goal for secondary prevention of cardiovascular events should be less than 55 mg per deciliter.

"We know that 80% or more of cardiovascular disease is preventable, and high LDL cholesterol, sometimes called 'bad' cholesterol, represents an important part of that risk," reports Roger Blumenthal, chair of the writing guidelines committee, in a note from the American College of Cardiology. Although our goal is to optimize healthy lifestyle habits as the first step in lowering cholesterol, we realize that if lipid values are outside the desired range after a period of lifestyle optimization, we should consider adding lipid-lowering drugs earlier thanwhich we did 10 years ago. And maintaining low LDL cholesterol levels for a longer period, just like maintaining low blood pressure levels for a longer period, provides better protection against future risk of heart attack and stroke."

What can be said in the end?" The calculator will help to organize the treatment plan. 'So the European system is better in therapeutic goals, but the new PREVENT algorithm recommended by these American leaders has shown the importance of what is important when cleaning the person and the beginning of theproblem," said De Luca.