Low-density lipoprotein (LDL) (“bad”) cholesterol is one of the most important modifiable risk factors for cardiovascular events. However, millions of people with cardiovascular disease (CVD) who have confirmed elevated LDL cholesterol levels (and even those with mild or moderate elevation) are not effectively managing their condition– leaving them at risk for a cardiovascular (CV) event, such as a heart attack or stroke.1,2
This challenge is in part due to a lack of emphasis on regular and recommended LDL cholesterol (LDL-C) testing, making it difficult for many people with CVD to achieve and maintain low LDL cholesterol. In fact, recent data shows that more than 40% of US adults are unaware they have – and therefore, are not being treated for – high LDL cholesterol.3
At the American Heart Association (AHA) Scientific Sessions 2023 in Philadelphia, Amgen had an opportunity to discuss this topic with Dr. Payal Kohli, an Associate Clinical Professor of Medicine at the University of Colorado Anschutz; Founder and Medical Director at Cherry Creek Heart; and On-Air Medical Expert at Tegna Broadcasting. Dr. Kohli shared her perspective on the importance of prioritizing LDL cholesterol testing and management among people living with CVD.
What is the benefit of regular LDL cholesterol testing?
Dr. Kohli: Without regular LDL cholesterol testing, it is like having a “blindfold” on when it comes to treating people living with CVD. Testing lipids regularly allows us to keep our finger on the pulse of what is going on with our patients to assess adherence to lifestyle modifications and treatment, as well as whether add-on therapy is needed to get patients below their LDL cholesterol thresholds. LDL-C levels are important for not just titrating lipid lowering therapy, but also for stratification of a patient’s cardiovascular risk.
Testing is also critical to our ability to assess how people respond to medications – to monitor response to initial therapy or any changes in a treatment plan. We also know that LDL cholesterol can vary through the course of a patient’s life – with factors like changes in weight, diet and menopause – so regularly testing lipids and ensuring that patients are iteratively evaluated is critical.
How do you encourage your patients with CVD to want to keep their LDL cholesterol levels down?
Dr. Kohli: I make it real for them. I tell my patients that the higher their LDL cholesterol, the greater their risk of having another cardiovascular event, like a heart attack or stroke. Suddenly, it doesn’t just feel like a number but feels like something they need to focus on to maintain their health. Because high cholesterol is asymptomatic, one of the hardest things for my patients to grasp is the implications of not treating or undertreating their LDL cholesterol is critical.
What advice do you have for healthcare professionals who prioritize other comorbidities, rather than LDL cholesterol?
Dr. Kohli: When we think about all the fires that healthcare providers put out during every visit – and there are a lot – we usually focus on conditions that patients complain about. We listen to the stories that patients tell us with their words, but too often we do not focus on the stories that the disease is telling us – for example, untreated high LDL cholesterol causally leading to a heart attack or stroke.
Knowing that the population attributable risk of lipids is one of the highest with respect to modifiable cardiovascular risk factors, even more so than diabetes and smoking, should motivate each provider to spend at least 2- to 3-minutes of every visit looking at a patients’ LDL cholesterol levels and determine how risks can be modified with lifestyle changes and, for some, with medication. Taking time out of our busy schedules to spend a few minutes assessing and treating LDL cholesterol can impact not just one person living with cardiovascular disease, but whole populations of individuals, and change the trajectory of their disease.
Dr. Payal Kohli is a paid consultant for Amgen.
REFERENCES
- Figorilli F, Mannarino MR, Bianconi V, Figorilli F, Mannarino MR, Bianconi V, et al., Cholesterol-Lowering Therapy in Patients at Low-to-Moderate Cardiovascular Risk. High Blood Press Cardiovasc Prev. 2022 Jul;29(4):327-336. doi: 10.1007/s40292-022-00529-2.
- Gu J, Sanchez R, Chauhan A, Fazio S, Wong N. Lipid treatment status and goal attainment among patients with atherosclerotic cardiovascular disease in the United States: A 2019 update. Am J Prev Cardiol. 2022 Mar 20;10:100336. doi: 10.1016/j.ajpc.2022.100336. PMID: 35368909; PMCID: PMC8968014
- Sayed A, Navar AM, Slipczuk L, et al. Prevalence, Awareness, and Treatment of Elevated LDL Cholesterol in US Adults, 1999-2020. JAMA Cardiol. Published online November 01, 2023. doi:10.1001/jamacardio.2023.3931
