The American College of Cardiology and the American Heart Association recently released new treatment guidelines aimed at preventing first heart attacks and strokes. According to the suggestions, some people currently taking a statin drug to lower cholesterol should stop – and millions of others who aren’t should start.

The guidelines ­represent a major paradigm shift. They move away from what rheumatologist Jon T. Giles, MD, assistant professor of medicine at Columbia University, calls “an overly narrow focus on LDL [“bad” cholesterol] cut-points for treatment” and instead focus on a person’s overall risk for developing cardiovascular disease (CVD) during the next 10 years. An online calculator that computes CVD risk considers factors such as age, gender, blood pressure, the presence of diabetes and smoking status, in addition to cholesterol levels.

As a result of the new guidelines, some people with moderately high cholesterol but no other CVD risk factors could be taken off their statin, while other people, including those whose cholesterol levels are not especially high, could be put on one, or put on a higher dose.

If you have osteoarthritis (OA), you may be more likely than before to be handed a prescription, says David Pisetsky, MD, professor of medicine at Duke University. That’s because people with OA tend to also have traditional CVD risk factors, such as being older and being overweight, he explains.

But what the calculator doesn’t take into account are inflammatory types of arthritis, such as rheumatoid arthritis (RA), psoriatic arthritis and ankylosing spondylitis. “People with RA, and likely those with other forms of inflammatory arthritis, are indeed at higher risk for CVD events and death from CVD. They also have poorer outcomes when treated for CVD events,” Dr. Giles says.

The reasons inflammatory arthritis puts people at increased CVD risk are complicated, but one of them is the fact that their cholesterol is likely to be oxidized, says Dr. Pisetsky. Oxidization, a process likened to rusting, makes cholesterol molecules more prone to invade artery walls, where they cause the most harm.

In addition, he says, these patients’ HDL, or “good” cholesterol, tends to become pro-inflammatory (causing inflammation) instead of anti-inflammatory. Inflammation is thought to play a role in heart attacks and strokes. Statins, which lower cholesterol, also help fight inflammation.