Cardiovascular disease is the number one cause of death in the U.S., and in many cases it is caused by a high level of cholesterol in your blood, which leads to buildup and blockage in the arteries. Today, new recommendation for doctors, published in the Journal of the American College of Cardiology, identifies four groups of patients who would most benefit from statin therapy to prevent and control high blood cholesterol.

“The focus for years has been on getting the LDL low,” Neil J. Stone, MD, Northwestern University, stated in a press release. “Our guidelines are not against that. We're simply saying how you get the LDL low is important. Considering all the possible treatments, we recommend a heart-healthy lifestyle and statin therapy for the best chance of reducing your risk of stroke or heart attack in the next 10 years."

Who Benefits Most From Statins?

Specifically, the new guideline recommends cholesterol-lowering statins (HMG-CoA reductase inhibitors) for these four groups:

  • Patients with cardiovascular disease;
  • Patients with a low-density lipoprotein (LDL or "bad") cholesterol level of 190 mg/dL or higher;
  • Patients between the ages of 40 and 75 with Type 2 diabetes; and
  • Patients between the ages of 40 and 75 with a 10-year risk of cardiovascular disease at 7.5 percent or higher (the report provides a formula to calculate risk).

Written by The American College of Cardiology (ACC) and the American Heart Association (AHA), the new guideline also emphasizes adoption of a heart-healthy lifestyle to control cholesterol. In particular, the report singles out those who are at high risk for cardiovascular disease caused by atherosclerosis — hardening and narrowing of the arteries. The guideline also suggests statin therapy is needed by those who already have atherosclerosis, because lifestyle changes alone would most likely be unable to prevent heart attack, stroke, and death.

Stone acted as chair of the panel of experts who wrote the new guideline based on their analysis of randomized controlled trials. The panel was tasked with outlining the optimal treatment of blood cholesterol to address the rising rate of cardiovascular disease. After a review of many cholesterol-lowering drugs, the panel chose to focus on statins.

"Statins were chosen because their use has resulted in the greatest benefit and the lowest rates of safety issues. No other cholesterol-lowering drug is as effective as statins," Stone stated. He noted that other cholesterol-lowering drugs can be used by patients who suffer side effects from statins. The new guideline also outlines recommended dosage of statin therapy for different patient groups while stressing lifestyle changes to manage cholesterol.

A Heart Healthy Lifestyle

In the U.S., about a third of adults have much too high levels of bad cholesterol, while elevated blood pressure also affects about a third of all adults. Teaming up again, the AHA and the ACC suggested nutrition and physical activity requirements for managing cholesterol and blood pressure. To lower cholesterol, particularly LDL cholesterol, the expert panel strongly recommends limiting saturated fat and trans fat. To lower blood pressure, the panel emphasizes restricting sodium consumption.

Saturated fat is found mainly in foods derived from animals, such as fatty cuts of meat and poultry with skin, and full-fat dairy products; tropical oils, such as coconut and palm oil; and trans fat contained in products made with partially-hydrogenated fat, such as many commercially prepared baked and fried foods. A study conducted by the Centers for Disease Control and Prevention indicated that avoiding foods with trans fat could prevent 10,000-20,000 heart attacks and 3,000-7,000 coronary heart disease deaths each year in the U.S.

To lower blood pressure, adults should consume no more than 2,400 milligrams a day of sodium, found mainly in salt, though it is preferable to limit intake to no more than 1,500 milligrams. The current average for adults is a whopping 3,600 milligrams (mg)/day — unhealthy excess.

Based on a 2,000 calorie per day diet, heart-healthy eating looks like this:

  • Fruits: 4-5 servings a day
  • Vegetables: 4-5 servings a day
  • Whole grains, preferably high fiber: 6-8 servings a day
  • Fat-free or low-fat milk and milk products: 2-3 servings a day
  • Lean meats, poultry, and fish: 6 or fewer ounces a day
  • Nuts, legumes and seeds: 4-5 servings a week
  • Fats and oils: 2-3 servings of healthy oils per day, limit trans and saturated fat
  • Limit sweets and added sugars

Finally, the panel advises moderate to vigorous aerobic exercise, such as brisk walking, for an average of 40 minutes at least three to four times a week. "Living a lifestyle that can reduce the risk of heart attacks, strokes, and other cardiovascular diseases includes both healthy eating habits and regular physical activity," Robert Eckel, M.D., professor of medicine at the University of Colorado Anschutz Medical Campus, said in a press release.

Sources: Stone NJ, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Journal of the American College of Cardiology. 2013.

Eckel R, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Journal of the American College of Cardiology. 2013.