Now the nation's first new heart disease prevention guidelines take a very different approach, focusing more broadly on risk and moving away from specific targets for cholesterol. The guidance offers doctors a new formula for estimating risk that includes age, gender, race and factors such as whether someone smokes
And for the first time, the guidelines take aim at preventing strokes, not just heart attacks. Partly because of that, they set a lower threshold for using medicines to reduce risk. They recommend using statin drugs such as Lipitor and Zocor, and identify four groups of people they help the most.
The guidelines were issued Tuesday by the American Heart Association and American College of Cardiology. Some doctors not involved in writing the guidance worry that it will be tough to understand.
Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel say the new approach will limit how many people are put on statins simply because of a cholesterol number. Yet under the new advice, one-third of U.S. adults — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of adults.
Current guidelines say total cholesterol should be under 200, and LDL, or "bad cholesterol," under 100. Other drugs such as niacin and fibrates are sometimes added to statins to try to reach those goals, but studies show they don't always lower the chances of heart problems.
Yale University cardiologist Dr. Harlan Krumholz, who has long urged the broader risk approach the new guidelines take said, "Chasing numbers can lead us to using drugs that haven't been proven to help patients. You can make someone's lab test look better without making them better".
They say statins do the most good for:
- People who already have heart disease.
- Those with LDL of 190 or higher, usually because of genetic risk.
- People ages 40 to 75 with Type 2 diabetes.
- People ages 40 to 75 who have an estimated 10-year risk of heart disease of 7.5 percent or higher, based on the new formula. (This means that for every 100 people with a similar risk profile, seven or eight would have a heart attack or stroke within 10 years.)
Dr. Donald Lloyd-Jones, preventive-medicine chief at Northwestern said, "Despite a small increased risk of muscle problems and accelerating diabetes in patients already at risk for it, statins are "remarkably safe drugs" whose benefits outweigh their risks."
Aspirin — widely used to lower the risk of strokes and heart attacks — is not addressed in the guidelines. And many drugs other than statins are still recommended for certain people, such as those with high triglycerides.
Patients should not stop taking any heart drug without first checking with their doctor.
The guidelines also say:
- Adults 40 to 79 should get an estimate every four to six years of their chances of suffering a heart attack or stroke over the next decade using the new formula. It includes age, sex, race, cholesterol, blood pressure, diabetes and smoking. If risk remains unclear, doctors can consider family history or three other tests. The best one is a coronary artery calcium test, an X-ray to measure calcium in heart arteries.
- For those 20 to 59, an estimate of their lifetime risk of a heart attack or stroke can be considered using traditional factors like cholesterol and blood pressure to persuade them to change their lifestyle.
- To fight obesity, doctors should develop individualized weight loss plans including a moderately reduced calorie diet, exercise and behavior strategies. The best ones offer two or three in-person meetings a month for at least six months. Web or phone-based programs are a less-ideal option.
- Everyone should get at least 40 minutes of moderate to vigorous exercise three or four times a week.
- People should eat a "dietary pattern" focused on vegetables, fruits and whole grains. Include low-fat dairy products, poultry, fish, beans and healthy oils and nuts. Limit sweets, sweet drinks, red meat, saturated fat and salt.
Original article: http://finance.yahoo.com
