by John Chapman, PhD
New medical guidelines often come with an intrinsic irony. The people they most stand to help, patients, are often the least informed about what the guidelines say. Stakeholders across Europe are determined to change that paradigm with new joint European Society of Cardiology/European Atherosclerosis Society guidelines on cholesterol management.
The guidelines are timely. While cardiovascular disease-related deaths are slowly declining across Europe, they remain a leading cause of mortality. Cardiovascular disease causes 3.9 million deaths in Europe each year.
These deaths are tragic in the truest sense – they are both sad and preventable. Now, the ESC guidelines could help to turn the tide on cardiovascular deaths by changing the way European patients and health care providers think about cholesterol.
So, what messages do the new ESC guidelines offer for patients? Allow me to highlight a few:
1. High cholesterol puts you at risk. For some time, people have laboured under the misconception that high LDL cholesterol, the “bad” cholesterol, was a biomarker, a bit like the indicator light in your car that signals engine trouble. That was wrong. We now know that LDL cholesterol is not just a risk factor; it is actually a causal factor in forming plaques in our arteries, and notably our coronary arteries. When these plaques rupture, a menacing blood clot can form, which may ultimately lead to angina or heart attack.
This increases the impetus to better manage LDL cholesterol levels.
2. Lifestyle and genetics matter. Patients can take control of their cholesterol by first taking a good look around them. Eating habits, tobacco use, weight management and regular exercise can be critical to maintaining a healthy cholesterol level. Patients with diabetes should recognise that they carry an added risk for cardiovascular disease.
Knowing one’s family history of cardiovascular health matters too. Talk with all of your family members; it’s critically important! Some patients, for example, inherit what’s known as familial hypercholesterolemia, or FH. Despite looking healthy on the outside, they may have a high risk of cardiovascular events such as heart attack or stroke.
3. Conversation with your doctor and the nurse at your clinical practice is key. Talking with your health care provider can help you to understand how your lifestyle, health history and family predispositions impact your cardiovascular health. Your health care provider can also advise steps to lower your LDL cholesterol as needed. That may entail lifestyle advice, such as changes in diet or exercise patterns. Prescription medications, from traditional statins, to inhibitors of cholesterol absorption in the intestine (ezetimibe), to cholesterol-lowering PCSK9 inhibitors, may also play a role.
4. Prevention begins with knowing your number. Imagine trying to slim down without first knowing your weight, or committing to reducing your alcohol consumption without knowing how many drinks you have each day. The idea of reducing your risk of heart attack or stroke without first knowing your LDL cholesterol level is equally problematic.
Patients need to work with their health care provider to identify their LDL cholesterol level. That number offers a valuable measurement of current health and existing risk. It also provides an important benchmark as patients work to reduce their LDL and improve their cardiovascular health.
The 2019 ESC/EAS recommendations offer patients and their families a bold opportunity, the chance to prevent heart attacks, strokes, and cardiovascular diseases that could cut their lives short. That’s also the chance to keep families intact, to allow children to grow up with healthy parents in the home, and to prolong the lives of aging adults who play a vital role in their families and communities. If we can diagnose those at risk early, then we can save lives!
Therefore, I urge health care providers to share the guidelines’ central messages with their patients. I urge patients to seek out their health care provider’s insight, to learn their number and to make an unflinching commitment to taking the necessary steps to reduce deadly LDL cholesterol.
Professor John Chapman, PhD, DSc, EFESC, is a member of The Task Force for the Management of Dyslipdaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).