New heart disease guidelines are recommending routine cholesterol screening starts at 19 or 20 years old and other tests to check heart health — potentially flagging more people for monitoring or treatment, according to a Florida cardiologist.
Heart disease fatalities have dropped by 66% between 1970 and 2022 because of a combination of lower smoking rates, better blood pressure management, advanced medical treatment and faster emergency care. Still, though, heart specialists see ways to do even better.
“We’ve generally been concerned that just checking cholesterol in and of itself does not explain why some people can have higher cholesterol and no heart disease,” said Dr. Rahul Aggarwal, a cardiologist with Jupiter Medical Center Physician Group.
“And we have other patients who have normal cholesterol have multiple blockages, and so having a more constant, more comprehensive approach than just checking the cholesterol is good,” he continued. “We’re looking at other risk factors. It’s a more comprehensive approach.”
What is the difference between ‘good cholesterol’ and ‘bad cholesterol’?
Cholesterol is a waxy substance your body uses to build cells and to make hormones. Your body needs some cholesterol, but having too much in your blood increases the risk of heart disease and stroke.
The American College of Cardiology, the American Heart Association and nine other leading medical associations last month issued an updated guideline for minimizing heart disease and managing abnormal level of lipids — either too much of the “bad cholesterol” (known as the low-density lipoprotein) or too little of the “good cholesterol” (also called high-density lipoprotein).
Among the recommendations in the new guidelines published last month:
∎ Screening children for inherited high cholesterol, once between the ages of 9 and 11, regardless of known risk.
∎ Screening adults for abnormal cholesterol levels starting at age 19 and every five years thereafter, regardless of risk factors.
∎ Adding lipid-lowering medications, most commonly statins, 10 years earlier than the current, standard practice, if healthy lifestyle changes involving diet and exercise have failed to produce the desired effect on abnormal cholesterol.
∎ Getting more aggressive in lowering “bad cholesterol” numbers significantly lower than the standard 100 mg/dl threshold for LDL when the patient has certain risk factors, such as adult-onset diabetes, a family history of heart disease, kidney disease, obesity and chronic inflammatory conditions like rheumatoid arthritis.
∎ Testing for calcium and proteins, some for at-risk patients and another that’s recommended at least once for all adults.
What screening is recommended for heart disease?
Aggarwal said he’s confident the new recommendations will become standard practice and organizations that recommend screening, such as the U.S. Preventive Services Task Force, will soon adopt the same advice.
Currently, that task force, which weighs benefits and harms of medical treatments and screenings, recommends prescribing statins for preventing heart disease for adults, aged 40 to 75, a decade older than the new advice.
This sort of advice is constantly evolving as new findings come in, however, Aggarwal said.
“This (discussion of new guidelines) probably will be started by primary care doctors,” Aggarwal said. “Thirty-year-olds generally don’t come into the cardiologist office.”
On the insurance side, though, the enthusiasm for more testing is more muted. Arthur Novoseletsky, senior vice president at Brown & Brown Insurance, a national insurance brokerage headquartered in Daytona Beach, said the insurance industry does want to pay for preventing disease, but there’s a limit.
“Our health care system is definitely hurting,” he said, noting the federal government’s recent move to eliminate enhanced Affordable Care Act subsidies. That “basically depleted a trillion dollars out of health care.”
Anne Geggis is an Aging Well reporter for the USA TODAY NETWORK FLORIDA who focuses on physical, mental, emotional and financial well-being as we age, from Gen Y to Boomers. If you have a question you would like Anne to find answers to, send it to ageggis@usatodayco.com. You can get all of Florida’s best content directly in your inbox each weekday by signing up for the free newsletter, Florida TODAY, at https://palmbeachpost.com/newsletters
This article originally appeared on Palm Beach Post: Why are doctors pushing for cholesterol screening to start at age 19?
Reporting by Anne Geggis, USA TODAY NETWORK – Florida / Palm Beach Post
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