Over the past several years, recommendations around managing lipids have become more patient-centered. The American Heart Association (AHA) and American College of Cardiology (ACC) 2018 Guidelines on the Management of Blood Cholesterol continue to emphasize many of the key elements that were part of their recommendations in 2013, including the importance of: 1) tailoring care to each individual based on their risk, and 2) working with them to explore their best options and overcome barriers to treatment.^1-3 There is a consistently strong focus on medications, which have strong data supporting their use. Lifestyle changes are also emphasized, recognizing that self-care is an important aspect of lipid management. This clinical tool explores how an Integrative Health perspective can broaden our approach to addressing lipids as key cardiac risk factor.

The Latest Professional Care Recommendations

As noted in the “Heart Health” overview, many factors contribute to heart disease risk. These all should be factored in as clinicians tailor care to an individual, and they are best considered within the even larger picture of a person’s overall health. Most expert panels focus on the Professional Care aspect of the Circle of Health; screening, preventive care, and medications receive significant attention. The majority of guidelines outline which medications should be considered and when, based on a person’s age, 10-year risk, and personal preferences. Medical management begins with statin drugs and expands from there.

The latest AHA guidelines mention 10 “Take Home Messages to Reduce Risk of Atherosclerotic Cardiovascular Disease (ASCVD) through Cholesterol Management.” These include the following:

1. For everyone, focus on a heart-healthy lifestyle throughout their life course. (This ties in nicely with the Integrative Health approach.)
2. In people with ASCXVD, reduce low-density lipoprotein cholesterol (LDL-C) with high-intensity statin drugs, or the strongest intensity they can tolerate.
3. Consider non-statin medications if people are very high risk, and keep LDL-C below 70.
4. Start high-intensity statin therapy in people with an LDL-C >190 even without calculating their 10-year risk. Add ezetimibe as needed, and consider other medications to keep levels under 100.
5. Start moderate-intensity statins in people 40-75 years old with diabetes if their LDL is >70.
6. Clinicians should have a “risk discussion” prior to starting statins for primary prevention (i.e., for people without known heart disease). All major risk factors should be reviewed (smoking, blood pressure, A1c, lipids, etc.), and a discussion of 10-year risk should occur. Risks and benefits of therapies should also be addressed. (This recommendation could tie in nicely with creating a Personal Health Plan.)