TUESDAY, Nov. 12 (HealthDay News) -- New guidelines introduced
Tuesday by the nation's leading heart experts could greatly expand
the number of Americans taking cholesterol-lowering statins.
The fundamental shift: Doctors are now being told to no longer
adhere to rigid clinical guidelines that trigger the use of a
statin when cholesterol levels reach a certain threshold.
Instead, people will be advised to take a statin if they already
have heart disease, if their bad (LDL) cholesterol is extremely
high (190 milligrams per deciliter of blood or more) or if they're
middle-aged with type 2 diabetes.
People between 40 and 75 years of age with an estimated 10-year
risk of heart disease of 7.5 percent or more will also be advised
to take a statin. Experts say this new rule could greatly alter the
number of patients who will now be advised to take such a drug.
In crafting the new guidelines, experts from the American Heart
Association and American College of Cardiology spent four years
examining the data on heart disease care. The new criteria for who
should take a statin also now factors in a person's risk for stroke
-- something experts believe may also boost the number of people
deemed eligible for the drugs.
"We focused specifically on the use of cholesterol-lowering therapy to determine what works best to reduce the risk of heart attack and stroke," Dr. Neil Stone, a professor of medicine at the Northwestern University Feinberg School of Medicine and chairman of the cholesterol committee, said during a press conference.
The revised cholesterol policy "suggests treatment should be
individualized and that, depending on your risk, you may need a
higher dose of a more potent statin than if your risk is lower,"
Dr. Hector Medina, a cardiologist at Scott & White Healthcare
in Round Rock, Texas, told
Statins, which include Crestor, Lipitor and Zocor, remain the
most effective drugs for reducing cholesterol and should be
combined with lifestyle changes for the best results, according to
the new report. This approach is better than trying to get
cholesterol as low as possible by combining statins with other
drugs, the report's authors said.
The committee also said matching patients with the appropriate
level of statin therapy is more important than achieving any
specific target number, as was common in the past.
For young adults, preventing high cholesterol in the first place
can go a long way toward avoiding heart attacks and strokes, the
About one-third of adults at risk for a heart attack or stroke
have not been diagnosed but could benefit from primary prevention
-- including taking statins -- according to the report.
Doctors should use known risk factors -- such as age,
cholesterol levels, blood pressure, smoking and diabetes -- to
assess cardiovascular risk. "These are the strongest predictors of
10-year risk for cardiovascular disease," Dr. Donald Lloyd-Jones, a
professor of preventive medicine at the Northwestern University
Feinberg School of Medicine and co-chairman of the committee, said
during the press conference.
Patients at risk of a heart attack or stroke within the next 10
years should get immediate drug therapy and be encouraged to change
their lifestyle, Lloyd-Jones said.
On the other hand, those at lower risk of heart attack or stroke
should be counseled to make lifestyle changes and probably do not
need drug therapy, he said.
Reducing obesity also cuts heart-health risks, and the new
guidelines may help doctors and their plus-sized patients devise an
effective -- and perhaps lifesaving -- weight-loss plan.
What works best are lifestyle changes, not crash diets, the
authors of the new guidelines said.
"Our recommendation is that doctors prescribe a diet to achieve reduced caloric intake as part of a comprehensive lifestyle intervention," guideline co-author Dr. Donna Ryan, a professor emeritus at Louisiana State University's Pennington Biomedical Research Center in Baton Rouge, said during the press conference. The diet should be tailored to patient preferences and any drugs they take, she said.
Diet, physical activity and face-to-face behavioral counseling
combined can lead to "clinically meaningful health improvement,"
Ryan said. "These benefits begin with weight loss in the range of 3
percent to 5 percent." The most effective behavior programs include
two to three meetings a month for six months or more, according to
Nearly 155 million American adults are overweight or obese,
which puts them at risk of heart attack, stroke, diabetes and early
death. Weight loss will lower blood pressure, improve blood
cholesterol levels and reduce the need for medication to manage
heart health, Ryan said.
For Americans, heart disease is the leading cause of death.
The experts said doctors should use a patient's body-mass index
(BMI) to assess whether a patient is obese or not. BMI is a measure
of body fat based on height and weight; a BMI of 25 or more is
"BMI is a quick and easy first screening step," Ryan said. Calculating BMI at least once a year will help identify those at a higher risk of heart disease and stroke because of their weight, she added. Waist circumference is also an indicator of risk.
Weight-loss surgery, also called bariatric surgery, may be the
right option for those who are severely obese (a BMI of 35 or
higher), especially if they have two other cardiovascular risk
factors, such as diabetes and high blood pressure.
This emphasis on obesity is critical, said Medina, who was not
involved with the report.
The problem? "Most patients don't think they are overweight or
obese even with a BMI above 40," he said.
Besides reducing obesity, the new guidelines emphasize the need
to maintain safe cholesterol levels, eat a healthful diet and
assess other risk factors for heart attack and stroke.
Healthy Diet and Exercise
A healthy diet -- not necessarily a low-calorie diet -- and
exercise reduce the risk for cardiovascular disease by lowering
blood pressure and cholesterol.
"Dietary patterns that are heart-healthy... include lots of fish, vegetables and whole grains, and limit saturated fats, trans fats and sodium," cholesterol committee co-chairman Dr. Robert Eckel, a professor of medicine at the University of Colorado Anschutz Medical Campus in Aurora, said during the press briefing.
A heart-healthy diet of 2,000 calories per day should
To reduce high blood pressure, limit salt intake to 1,500
milligrams a day, the committee said. U.S. adults currently consume
an average of about 3,600 milligrams a day.
One key to heart-healthy eating is avoiding trans fats, which
serve no nutritional purpose but are often added to foods to extend
shelf life or improve texture. The U.S. Food and Drug
Administration announced a plan last week to ban these man-made
fats from all processed foods. These are often listed on labels as
partially hydrogenated oils.
The guidelines also recommend moderate- to vigorous-intensity
aerobic exercise, such as brisk walking, for about 40 minutes three
or four times a week.
For more information on preventing heart attack and stroke,
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.