Until five years ago, the decision to treat people with cholesterol-lowering drugs was based almost exclusively on their LDL (“bad”) cholesterol levels. That changed with the guidelines from ACC/AHA in 2013 and the U.S. Preventive Services Task Force in 2016, which focused instead on overall cardiovascular risk. People above a certain estimated likelihood for cardiovascular events are judged to be at high risk and thus are candidates for statins.
According to the ACC/AHA guidelines, you are at high risk if you have had a cardiovascular event (such as a heart attack or stroke) or have very high LDL (190 or above). You are also at high risk if you are between the ages of 40 and 75 and have diabetes or have a 10-year risk of having a serious cardiovascular event of at least 7.5 percent as determined by an online calculator. Intermediate risk is 5 to 7.5 percent.
According to the Task Force’s somewhat more lenient guidelines, which use this same calculator, high risk is a score over 10 percent (when accompanied by at least one risk factor, such as diabetes, hypertension, or smoking), and intermediate is 7.5 to 10 percent. Some other experts deem a 10-year risk between 5 and 20 percent to be intermediate.
Based on this calculator, President Trump’s 10-year risk, based on results from his 2018 medical exam, is about 17 percent—quite high.
This article first appeared in the UC Berkeley Wellness Letter.