A Buildup Of ‘Bad Cholesterol’ Can Lead To Atherosclerotic Cardiovascular Disease. Here’s What To Know About It And The New Way To Treat It.
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How much do you know about atherosclerosis cardiovascular disease? If the answer is “nothing,” get familiar with it, because 21 million people in the U.S. have been diagnosed with it and are at risk for a cardiovascular event.

Atherosclerosis, or ASCVD, is a fatty buildup in the inner lining of one’s artery, or “atherosclerotic plaque,” which is caused by an accumulation of bad cholesterol (LDL). If allowed to progress, people won’t experience a significant symptom until it’s too late — when the plaque ruptures, which leads to a heart attack or stroke. Lipid-lowering therapies, like statins, can help, but often, not everyone who needs them are receiving them, and if they are, sometimes they’re just not enough to lower cholesterol to recommended levels.

“There are some significant disparities in the management of this disorder,” says Dr. Charles Lovell, internal medicine specialist and assistant professor of clinical medicine at Eastern Virginia Medical School. “There are race-based disparities. Black Americans above 45 have higher cholesterols, are less likely to be receiving statins, and they are also less likely to reach the LDL goal of less than 70. A large VA study looked at gender-based disparities and the VA study basically reported that women, the female gender, were independently associated with lower likelihood of receiving statins and particularly of high instance of that. So we have the global public health burden, and then we have these unique challenges based upon race and gender.”

There are new methods of treatment that are making a difference, if you can gain access through your provider. The FDA recently approved Novartis Leqvio®, which provides sustained lowering of bad cholesterol. It’s an RNA therapy only requiring two doses a year. Dr. Lovell says it reduces the liver’s ability to absorb LDLs.

“What’s really novel about this drug, it’s only administered twice a year, every six months. The patient comes to the office and gets a subcutaneous injection every six months,” he says. “Now, when they begin therapy, they get an injection, and then three months later, they get a second injection. And after that, they literally get an injection every six months. So when you worry about clients taking the drugs on schedule, not missing doses, here you have a product that has a major effect on ensuring compliance.”

But one can’t lean on medication alone while eating whatever, living however. Dr. Lovell stresses the importance of adopting a healthier lifestyle to have the best results in regards to keeping bad cholesterol low and avoiding a cardiovascular event.

“We are talking about diet, exercise, avoidance of smoking, and very, very careful or no use of alcohol,” he says. “So when we look at diet, we are talking about trying to keep total calories between 1800 and 2000 per day. And we’re talking about keeping saturated fat, which is the fat that really drives the bad cholesterol up, that should be kept to no more than 10 percent per day. And for people who have atherosclerotic disease, it should be seven percent. Exercise should be five days per week, 30 minutes per day, moderate or three episodes per week of more intense exercise.”

And in addition to trying to have a healthier lifestyle, which Dr. Lovell notes is a great foundation, you have to be serious about knowing your numbers and going to the doctor, equipped with the tools to give yourself the best chances at protecting your heart health.

“Know the numbers you need to achieve and advocate for your own health,” Dr. Lovell says. “Not all physicians are sufficiently aggressive in reaching those goals. Then challenge your physician and say, ‘Doctor, I’ve read that my LDL cholesterol should be this number’ or my blood pressure, this number, or my hemoglobin A1C this number. I think patients have to be stewards of their own health, know the guidelines themselves. And when they interact with their physicians, make sure their physicians are treating them and are advancing treatment until they get to the goals that they need to achieve to reduce their risk.”

“This is a disease that kills and it maims. It causes amputations, it causes paralysis, but we have great treatments,” he adds. “Now we have statins, which have been validated. But the statins, in most cases, won’t do it alone. And now that we have this novel treatment that can be administered just twice a year and lower cholesterol, 52% on top of statin, we should be able to have a major impact on cardiovascular, atherosclerotic cardiovascular diseases.”