New Guidelines for Heart Disease, Stroke Prevention

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February 4, 2014


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The nation’s leading experts on cardiovascular health have adopted new guidelines for preventing heart disease and stroke. They are now placing more focus on obesity, diabetes and other risk factors, while relying less on cholesterol levels.

“This is about updating guidelines that we’ve been using for a long time,” says Jonathan Fialkow, M.D., medical director of clinical cardiology at Baptist Cardiac & Vascular Institute. “We’re targeting the people who are at much higher risk for heart disease or stroke at an earlier point in their lives. Earlier treatment improves the chances of avoiding problems.”

About 610,000 Americans have a first stroke every year. Another 525,000 have a first heart attack. But these risks can be lowered through lifestyle changes and, in some cases, medications such as statins, according to American Heart Association.

The updated and expanded guidelines — published in November — now include treating obesity as a disease and providing other resources to treat risk factors, such as diabetes and high blood pressure.

The four areas of focus now include:

  • Cholesterol levels.
  • Lifestyle (diet and exercise).
  • Obesity.
  • Risk assessment.
  • Experts pored over hundreds of clinical research studies before developing recommendations about what works best in order to equip doctors across the country with the most up-to-date research.

    There are also many people to whom the new guidelines don’t apply, Dr. Fialkow says.

    And remember: Your doctor still has the final word. That’s because every individual with heart disease risk factors poses a unique challenge and may require different treatments based on lifestyle, family history and testing results.

    A New Approach to Treating Cholesterol
    Measuring cholesterol is still a vital component. But, under the new guidelines by American Heart Association (AHA) and the American College of Cardiology, the formula for evaluating who needs to take cholesterol-lowering drugs, also referred to as statins, is broader.

    The intended end result: more people in need of statins will get them.

    Doctors say the new approach will limit how many people with low heart disease risks are on cholesterol-lowering medication — simply because of a cholesterol number.

    But for those with a high-risk for heart disease, the revised guidelines might expand the number of patients on statins. Here’s why:

    Due to the new guidelines, 33 million Americans — 44 percent of men and 22 percent of women — would meet the threshold for taking statins. Under the old guidelines, statins were only recommended for about 15 percent of adults. That’s because the old recommendations only considered a person’s risk for heart disease, leaving out the risk for stroke.

    “But it’s not just about cholesterol,” Dr. Fialkow stressed. “There is much more involved in looking at one’s health, including obesity, diabetes and family history. These guidelines are less focused on cholesterol levels before and after treatment.”

    Nonetheless, the new focus moves away from treating patients with drugs until their so-called “bad cholesterol,” or LDL, hits a specific target – one that for most people is all but impossible to achieve by diet alone.

    Four Categories for Statin Therapy
    The new guidelines group adults into the four categories most likely to benefit from cholesterol-lowering drugs. The categories include people diagnosed with heart disease and diabetes, as well as those with high levels of LDL cholesterol.

    The guidelines recommend statin therapy for the following groups:

  • Men and women, ages 40 to 75, who do not have cardiovascular disease, but have a cardio “risk score” that shows a 7.5 percent or higher risk for developing a heart attack or stroke within 10 years.
  • Patients with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.
  • People 21 and older, who have a very high level of bad cholesterol (190 mg/dL or higher).
  • Those with Type 1 or Type 2 diabetes who are 40 to 75 years old.
  • New Equations to Measure Risks
    For those in the 40-79 age group, new “equations” are recommended to measure a person’s risk for a heart attack or stroke within the next 10 years.

    To calculate the 10-year risk, the equation uses race, gender, age, total cholesterol, HDL (good) cholesterol, blood pressure, use of blood pressure medication, the presence of diabetes and smoking status.  A separate formula — starting at age 20 — is available to estimate a person’s lifetime risk.

    Combating Obesity with Lifestyle Changes
    Obesity should be treated like a disease, and doctors should steer their patients toward lifestyle changes that include a healthy diet and regulator exercise, according to the AHA and the American Stroke Association.

    The best strategy to lose weight and keep it off requires a three-pronged approach: Eat fewer calories than your body needs; exercise more, and change unhealthy behaviors, the two associations say.

    Patients are more likely to stay on track when guided by a trained professional in a healthcare setting. That’s why doctors are now urged to more actively help their patients achieve and maintain a healthier body weight, possibly referring them to nutritionists and certified trainers.

    “In the end, what we’re trying to do is to individualize assessments as much as we can,” Dr. Fialkow says. “Instead of raw metrics, we are using more information on that particular person to determine treatment.”

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