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If there are doubts about your level of risk, a test that measures coronary artery calcium can add useful information to the discussion. Coronary artery calcium, often referred to as CAC, is the amount of calcium that has built up along the inner lining of the heart’s arteries. A higher level of buildup is linked with a greater risk of a heart attack in the future. The test can help identify people who may benefit the most from cholesterol-lowering medications. A coronary calcium scan is often done in a hospital or other medical imaging facility. If your risk is high, you should consider treatment to lower your cholesterol.
Treatment Choices
When it comes to managing cholesterol, no one approach works for everyone. The 2018 guidelines offer advice on treating different patients. The process involves looking at a person’s risk and tailoring steps to his or her needs. For example, your race or ethnicity may affect your risk of heart disease. The 2018 guidelines explain in greater detail than before how being Asian American, black, or Hispanic or Latino can factor into treatment choices. It makes sense to discuss this information when deciding which statin — the first choice for medicine to lower cholesterol — to use or what the dose should be.
Statins
The first line of treatment for patients with high risk — along with a healthy lifestyle — is medication to lower cholesterol, starting with statins. Statins have been used since the 1980s to help lower cholesterol and reduce the risk for heart events.
Statins lower cholesterol by reducing the liver’s ability to make cholesterol. This, in turn, allows the liver to accept more cholesterol from the blood, thereby driving down cholesterol levels in the blood. They can drive down LDL cholesterol levels by more than 50 percent.
Statins also appear to help prevent heart attacks and strokes by keeping plaques from breaking apart and forming clots that can move to the heart or brain. In addition, they can lower triglycerides and slightly boost high-density lipoprotein (HDL) cholesterol, known as the “good” cholesterol.
Non-Statins
When statins cause side effects or don’t lower cholesterol as well as they should, other treatments may be added or offered. These options may include ezetemibe and PCSK9 inhibitors, which are non-statin drugs that also can reduce cholesterol and heart risk. However, these treatments are much newer and often given only to those who don’t succeed with standard treatment or need additional cholesterol- lowering given their risk of having a first or second heart attack or stroke.
Taking Your Medicine
About 56 million adults in the U.S. are taking or are eligible to take statins, according to a National Health and Nutrition Examination Survey. This number may change in light of the 2018 cholesterol guidelines. However, not everyone takes medicine as instructed. If you have high cholesterol, it’s important for you to understand the need for treatment and, if you are given medicine, how to take it as directed.
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