How many times you've heard the warning that you should watch your cholesterol if you want to keep your heart healthy?
But not all cholesterol is that bad. It is actually an essential source that provides the cells in your body with needed fat. The type to blame for putting your heart at risk is LDL, or the "bad" cholesterol.
The LDL's full name is "low-density lipoprotein" and it's made up of an outer rim of lipoprotein and a cholesterol center. The bad thing about LDL is that it can become a part of plaque that can clog arteries and cause heart attack and stroke.
A medical theory that links blood cholesterol levels and occurrence of heart disease is called lipid hypothesis and it's accepted by most of the medical community for years.
However, in a dispute referred to as the "cholesterol controversy", a minority claims that the evidence does not support this hypothesis, and that mechanisms independent of blood cholesterol levels are responsible for cardiovascular disease.
Some of the studies written and supported by "cholesterol skeptics" controversially claim not only that there's no link between cholesterol and heart disease, but also that older adults with higher bad LDL cholesterol live longer than peers with low levels of same cholesterol.
However, studies like this are controversial mostly because of many limitations, including missing relevant studies in search methods, not including the levels of other blood fats (e.g. total and HDL cholesterol), the possibility that other health and lifestyle factors are influencing the link, and most importantly, not taking account of statin use, which lowers cholesterol.
When it comes to cholesterol, despite controversies, "lower is better" remains a common sense and accepted practice among majority of medical community. Last year (2016), the American College of Cardiology (ACC) supplemented their 2013 guidelines with recommendations that focus on LDL targets and management.
ACC also develop amazing mobile apps for medical providers who treat patients with cardiovascular diseases, or who are at risk of developing one. We already reviewed some of them here on SteadyHealth, one of the most recent being BridgeAnticoag app.
They've added another mobile app to the bunch called LDL-C Manager that focuses on LDL management and providing recommendations to healthcare providers.
Basically, the LDL-C Manager combines three other ACC's stand-alone cholesterol apps in one, including ASCVD Risk Estimator that calculates pre-treatment ASCVD risk and determine if statin therapy is appropriate for patient, LDL-C Lowering Therapy that assess response to statin and considers other therapies, and finally Statin Intolerance (also available as the stand-alone app we reviewed before) that evaluates patient for possible statin intolerance.
These three tools are available on the main screen as you open the app. While the first two open the tools within the app, Statin Intolerance links to the ACC website, which was surprising considering that they made the app that could be easily implemented within this one.
However, all tools work great providing the recommendations to medical providers that treat patients with ASCVD risk that have or have not started statin therapy.
I won't analyze ASCVD and Statin Intolerance sections because they've been already reviewed as stand-alone apps here on SteadyHealth. You can read our review of ASCVD Risk Estimator app here, as well as review of Statin Intolerance app.
I would rather focus on LDL-C Lowering Therapy section that access patient's response to statin and provides recommendations and considerations, particularly for other therapies.
Let's take a look at a clinical scenario in which we have 66 year old female with no history of cardiovascular disease, on low dose of simvastatin and current lipid panel showing an LDL-C of 102 mg/dL. Her baseline LDL-C before statin therapy was 148 mg/dL, so we want to see if her current lipid lowering treatment is working, or if it should be modified.
I've entered all the information about the patient and the app has shown that LDL-C reduction was acceptable with 31.1% on low statin, but her current LDL-C was a little bit above ACC suggested levels. The app suggested that patient should optimize the current lifestyle and medication therapy, by increasing current statin to moderate or high-intensity.
Also, since the patient has family history of ASCVD, the app suggested adding non-statin medications, such as ezetimibe, of course with additional considerations.
The LDL-C Manager app is straightforward and very easy to use, with familiar interface of other ACC's apps. Beside useful 3-in-1 tool and calculators, it includes the evidence based guidelines and that brought back LDL targets.
The useful addition that is currently missing in LDL-C Manager app would be more evidence-based recommendations that would help providers calculate LDL treatment intensification regimens. They're currently based solely on expert opinion and must be discussed with each patient appropriately.
However, this doesn't ruin the overall impression. The LDL-C Manager app is still a must have medical app for all providers that need multiple guidelines for the cholesterol management in one app.
Benefit: Providers who manage patients with hyperlipidemia and/or ASCVD risk factors that may require statin therapy, would benefit from this app