In the history of cholesterol guidelines, the new 2013 cholesterol guideline is the only one that puts the decision to treat high cholesterol for prevention of heart attack and strokes in the hands of the patients.
This part of the cholesterol guideline is not about your cholesterol levels but it is about you. This applies to you only if you have not had any heart attacks or strokes in the past. If your had heart attacks or strokes, you need the cholesterol medicine. They strongly recommend it regardless of your cholesterol levels.
This particular point in the guideline includes majority of patients that are unnecessarily worried about their cholesterol levels. The following example will illustrate my point.
Let us assume you are a 45 year old man with a wife and 2 kids. You have been healthy most of your life and have a good paying job. You have a very happy family. You decide to buy a term life insurance policy. They need a physical to quality you for their preferred rate policy. As a part of the physical, you get your cholesterol checked. Lets us say your LDL cholesterol comes back at 180. The doctor gives you a diagnosis of high cholesterol. Now, you have something to worry about. Suddenly, there is great deal of stress in your family.
Now, let us explore what the new guidelines actually say. They have divided LDL cholesterol levels into there different categories.
If it is less than 70, they do not recommend any treatment for someone like you.
If it is greater than 190, they think treatment may be beneficial. But the recommendation is based on very weak evidence. They are not confident enough to tell you what exactly you need to do.
Things get really fuzzy when your LDL cholesterol levels are in between 70 and 189. There may be some benefits in starting a specific class of cholesterol medications called statins if your risk of having heart attacks and strokes are high. But the treatment with cholesterol medications have some risk too. The question is which risk you would like to take. Would you like to take the slightly increased risk of heart attack or would you like to take the risk of getting adverse effects of the medications?
That is a tough choice but the guideline makers clearly gave that choice to you. It specifically tells the doctors to inform patients about the risks and benefits and let them choose.
So, what are the things you need to consider when making that decision?
They have a tool to calculate your 10 year risk of having heart attacks or strokes. Besides age, sex and race, it also has things like your total cholesterol, your blood pressure, your history of diabetes and your smoking status. If the 10 year risk is less than 7.5%, there is little evidence of benefit from the medication. If the 10 year risk is greater than 7.5%, you may benefit from taking cholesterol medication but you have to accept the risk of adverse effects from the cholesterol medicines.
One thing that gets lost in this equation is that cholesterol is only a small part of the overall risk for heart attacks and strokes. Stress is definitely a big factor that can cause heart attacks and strokes.Do not let the stress of dealing with high cholesterol increase your risk.
You can decide to take the cholesterol medicine as long as you do not forget to do other things that will lower your risk of heart attacks and strokes. Remember, cholesterol is just a small part of the equation. You need to regard your cholesterol medication as a small thing you can do to lower your risk a little further; it is not the complete solution. You still need to focus on healthy living, exercise, quit smoking, healthy diet and maintain good blood pressure.
You can decide not to take the cholesterol medicine if you are confident about the other things you can do to lower your risk. If you are determined to do all the other things properly and live a healthy life, the small increase in risk from your cholesterol may be insignificant.
The new cholesterol guideline does not make that decision more complicated. It makes it simple, it is about your personal choice and how you want to live your life.