How Early Should You Check Your Cholesterol?

know by now, this is the show where we dig into the questions that you are sending in that you are writing in from all over the country, frankly, all over the world. In these episodes are some of my favorites because I get to hear from you. I get to hear your questions, but so many of you share your stories as well, which I really appreciate and things that are trying to make sense of. And with that, our producer Kira's back with us, what

do we have first? Hey Sanjay. Okay, so first up in actually going to be asking what

am I own questions? So I just saw these new cholesterol guidelines that came out and we're hearing that millions more people could be told to start treatment earlier, like in their 30s. I'm almost 30. So I had a mildly alarming thought, like in my already supposed

“to be thinking about statins, I think a lot of people assume high cholesterol is something”

that you worry about later in life, but now we're hearing something a little bit different. So Sanjay, what are these new recommendations actually telling us? Okay, Kira, well, first of all, I think a lot of people had the exact same reaction I've been talking to people around the country, but also people in my own hospital. Doctors trying to make sense of all this. And I think the headline here is don't panic. These new recommendations are about

catching risk earlier before bad cholesterol has had years and years to build up in your arteries. So after the break, we're going to talk about what is actually changed and who really needs to pay attention. Stay with us.

“All right, so new guidelines, 120, 3 pages of new guidelines, which I have read for you.”

And I want to give you some of the headlines first and then dig a little bit into it in terms

of trying to make sense of it for you. For years, a lot of cholesterol decisions were based on a 10 year risk of having some sort of heart problem or a stroke. Okay, so typically around age 40, people would really start to dive into these risk factors and they would ask the question, what is the next 10 years look like for you? What is your risk over the next 10 years? What these new guidelines do is push that conversation earlier. So instead of waiting until 40,

the recommendation is to start thinking about screening and in some cases treatment, beginning around age 30. So everything frame shifts 10 years earlier and also instead of thinking about just the next 10 years, thinking about 30 year risk or even lifetime risk. And the idea is that even if you're 10 year risk was low, if you have high levels of bad cholesterol and your body is increasingly exposed to that high cholesterol, that can be a problem.

That can be an opportunity for plaque to build up in your arteries and potentially cause problems later on. When I have to summarize these guidelines, what they're really saying is that an LDL, that's low density lipoprotein. That's the bad cholesterol. If it's 160 or higher, if you have a strong family history of premature heart disease and you have

a high long-term cardiovascular risk. So first of all, turning 30 does not mean everyone

suddenly needs a statin. That's not what they're saying. But it might mean that millions more people who previously were not on medications might be getting a recommendation from their doctors about potentially taking one. But overall, I think the biggest headline here is to think about screening. A lot of people just don't simply know their numbers at all and you want to be thinking about these numbers as early in life as possible, how early. Well, according to

these guidelines, they're saying between the ages of 9 and 11. So 9 years old to 11 years old,

“that is the first time you should probably get at least one comprehensive screening of your cholesterol”

and your lipids. Then again, at age 19, right as you come out of adolescence and every five years after that. And then at age 30, getting all these numbers checked, but also calculating your risk based on something known as a prevent calculator, which you can find for free online. And that's going to give you a good sense really now of what your risk is over the next 30 years to the

might still be the right answer for the majority of people. But this is something to start thinking

“about earlier. Now, as I mentioned, a lot of questions coming in on this. Kira, what do we have next?”

All right. Next up is Juan and Florida, who wants to know, will doctors begin to incorporate testing LPA levels for their patients? All right. I'm so glad this question about LPA lipoprotein A or LPA little A. That's the way it's often referred to. I'm so glad there's questions coming in

about this because this is really important. This may be the most important thing you learned

overall from these guidelines. Because a lot of people know cholesterol. They know bad cholesterol. They know triglycerides. But you may have never heard of LPA little A. It's a cholesterol particle. It's similar to LDL cholesterol or the bad cholesterol. But LPA little A is stickier. Okay. Think about it. Being stickier and something that's able to build up an arteries and increase your risk of having some sort of heart problem. But here's a really interesting thing about LPA

little A. It's largely genetic. That means it's fixed. That means that lifestyle factors like exercise and diet or lack of exercise and diet won't really change LPA little A. It's pretty static. Which means you probably only need to get it checked once in your life. It's not really going to change over your life. So why do you want to test for it? And about 20% of the adult population in the United States has elevated levels. If you have high levels of this, that might push you to

reducing your other cholesterol levels even more. So let's say you're sort of borderline with regard to your bad cholesterol. But you have a high LPA little A. Your doctors are more likely to be aggressive in terms of lowering your cholesterol. Now, if you have a low LPA little A in your borderline, the doctors may say, hey, look, let's try lifestyle changes more aggressively and see if we can avoid taking a statin. But one thing to keep in mind, statins, as well as lifestyle

changes, they're not going to lower your LPA little A. Again, that is largely genetic. That is largely fixed. There are specific drugs that are being investigated nowadays to try and lower LPA little A. But they're not out as of yet. All right. Now, a lot of people here are statin and they immediately understandably worry about side effects coming up. We'll get into what is

“real, what is rare, and what you should actually know. That's after the break.”

This week on the assignment with me, Audie Cornish. I have always believed about myself and told

people that I don't have an addictive personality, because I don't have a lot of biases. I'm a Mormon. I don't drink. I don't smoke. I've never tried drugs. Anything like that. I guess today is a staff writer for the Atlantic. His name is McCake Hopkins. He spent $10,000 of his employers money and an entire NFL season diving into the world of online sports betting. I just believe that it would be a funny little side plot in my broader investigation of

the sports betting industry. I genuinely did not expect that it would kind of take over my life. Listen to the assignment with me, Audie Cornish, streaming now on your favorite podcast app. And sharing our love for Valerie Jarvis. As someone who has loved his show for years, it's wild to see just how much the world has changed since we last saw her.

“All right, I hear the pageur again, Gira. Who do we have next?”

Okay, Sanjay. We have Ryan from California asking, "How common do each of the side effects from statins occur?" All right. Common side effects from statins. First of all, let me just dial back for a second and talk about this whole concept philosophically. If you think about the fact that we're going to be screening earlier and potentially putting people on statins earlier, that's a concern. That means a lot more people maybe getting medicated. A lot of people will

stay on those medications for a long time if not their entire life. And I just think as a society,

we always need to be judicious about adding more and more medications to the mix.

Now, in terms of specific side effects, the most reported side effect is muscle pain muscle aches. Now, clinical trials, the percent of people who experience this, relatively small,

that people actually want to stop taking the medication they simply can't tolerate it.

“Increasing your blood sugar. That's another known side effect. And part of the issue here is that”

statins seem to make you insulin resistant. So you're insulin, which lowers your blood sugar is not working as well. So insulin resistance leads to hyperglycemia, high blood sugar, and in some cases could tip people over into diabetes less than a 1% chance of that happening. I will tell you just something in general about side effects. People report different possible side effects. All those are looked at. There was a great article about this in the

Lancet. So there were 66 possible side effects that were reported from people who started statins. They take a look at those side effects. They compare that to the general population of statin users and the general population overall. And when they do that, they find that there were four things that were real. Other things were more artifacts. The four things that were real again, muscle pain we talked about, hyperglycemia, elevated blood sugar, and then changes in

liver function and kidney function. But beyond the muscle pain, the risk of the other things was pretty low again, less than 1%. When you start statins, your doctor will likely say, hey, before you actually start taking the medication, let's check your liver function for those liver enzymes. And then again, a few months into taking the statins, they'll probably want to check again. Even though the risk is low of having some sort of liver problem, that's an easy test to perform

to make sure your liver is not taking a hit from these new medications. Okay, Kira, time for one more question. So last up, we have Talkber, who takes a statin, and he says he follows his doctor's advice on exercise and diet, but wants to know if he only to use it for the rest of his life,

or until bringing the cholesterol to lower limits. Well, first of all, Talkber, I just want to say

that lifestyle changes diet and exercise are still going to be the gold standard in terms of the advice you're going to get. It's not going to help with LP little A, that is largely genetic, but lifestyle changes exercise and diet can make a difference for a significant percentage of people

“who are trying to lower their cholesterol. And even if you start taking statins, you should still”

be implementing lifestyle changes. So question, will you have to be on a statin for the rest of your life? The short answer is typically most patients are, especially those who are taking statins to reduce the likelihood of having another heart attack or stroke. So that means this is secondary prevention. They've already had a heart attack and now they're taking statins to prevent a second heart attack. That's secondary prevention population. Most of those people stay on statins for their

whole life. There's another group of patients who are using it for primary prevention, which means

they've never had a heart attack or stroke. They're now using the statin to prevent that from happening

in the first place. And again, the vast majority of those people will be on these medications for the rest of their life. When I looked up the most recent data, they found that about one in 77 people are able to come off the statins. And in those cases, it's because their cholesterol levels go low and they stay low, even when the statins are removed. So there you have it. New guidelines for heart disease and keep in mind, heart disease is still the biggest killer of Americans,

“men and women alike. So this is a big deal. I think one of the headlines you should take away from”

this is L. P. Little A. Lipo protein A. Maybe something you've never had checked. Get a check. You only have to have a check once because it is genetic. It's not likely to change, but that can influence a lot of the other decisions we've talked about today. And that is a wrap for today's episode. Thank you so much to everyone who sent in the questions. This show would not exist without you. And I'm glad you're part of it. No question is too big or small. No question is embarrassing.

We might just answer whatever is on your mind in our next show. Record a voice memo, email it to [email protected]. That's paging [email protected]. We're give us a call 4703960832 and leave a message. Thanks so much for listening. I'm CNN Tech reporter Claire Duffy. This week on the podcast Terms of Service, there's a growing category of products aimed specifically at addressing women's unique health needs.

These tools and services are sometimes known as femme tech, and they could provide big opportunities and benefits, but they can also come with some risks. To walk us through all of this,

startups, clinicians, and healthcare organizations. In my opinion, what it really does is gives us

“a collective language to talk about women's healthcare innovation and the tools that are out there”

so that we can take control of our healthcare experiences and know how to advocate for ourselves

and a system that's probably not been designed to advocate for us. Listen to CNN's Terms of Service

wherever you get your podcasts.