More Americans than ever are living with heart disease — and it is killing us. Heart disease and stroke are the number one and number four causes of death among both men and women, and as a result, the American Heart Association and the American College of Cardiology have released new prevention guidelines to help reduce both the number of people living with cardiovascular conditions and the number of heart disease-related deaths.
The new prevention guidelines are based on a comprehensive review of clinical studies conducted by the National Heart, Lung, and Blood Institute over the past decade. While the new guidelines do not include any significant changes to recommendations regarding diet and lifestyle (maintaining a healthy weight, not smoking, eating plenty of fruits and vegetables and low-cholesterol foods, and exercising regularly are still the cornerstones of heart disease prevention) they do place a greater emphasis on using drugs to treat cholesterol, treating obesity, and making allowances for occasional indulgences. The new guidelines also specifically address the heart disease and stroke risk for African-Americans, which are different from those of other ethnicities.
Increase Use of Statins
Statins are drugs that reduce the amount of cholesterol in the blood. Currently, about 25 million Americans take one of the seven available statins, including Lipitor.
Typically, statins have only been prescribed for those who already have high cholesterol, or who have a 20 percent or higher risk of having a heart attack within the next 10 years. However, those guidelines do not take into account stroke risk, and tend to leave out a large number of patients who could benefit from statin use in the long term.
Under the new guidelines — which experts predict could double the number of people taking the drug — statins should be prescribed to anyone between the ages of 40 and 75 who have a 7.5 percent risk of having a heart attack or stroke within the next 10 years, even if they do not currently have cardiovascular disease. This means that even relatively healthy people who have a family history of heart disease, for example, could be prescribed statins to reduce their risk.
Other people who would be considered candidates for statins under the new guidelines include:
- Young people (age 21 and up) with “bad” cholesterol of 190 mg/DL
- Diabetics (both Type 1 and 2) between ages 40 and 75
- People with a history of cardiac events, including heart attack and stroke, regardless of age
While the new guidelines have the potential to increase the number of people taking statins, some doctors caution that the guidelines are just that, and that in some cases, lifestyle changes can reduce the risk of heart disease as much as or more than statins.
For example, a smoker who has no other risk factors or current heart disease may benefit more from quitting than from taking drugs. Still, the AHA believes that increasing the use of cholesterol-lowering drugs will do more good than harm, and will reduce the number of heart-disease related deaths.
Treat Obesity as a Disease
We’ve all seen the headlines: Americans are overweight. Almost 78 million Americans are considered obese, a condition that creates a host of health issues, including cardiovascular disease. However, the old AHA guidelines indicated that an overweight patient must have at least two additional risk factors for cardiovascular disease in order for weight loss to be considered an effective preventive or treatment measure. Under the new guidelines, though, shedding extra pounds can help reduce risk even if you only have one other risk factor, such as high blood pressure.
Perhaps more significantly, though, the new guidelines encourage doctors to treat obesity not as a lifestyle issue, but as a disease. This means that doctor should actively address patients’ weight, by incorporating education, behavioral counseling, and obesity screenings into their treatment plans. In some cases, patients may be prescribed a medically supervised weight loss plan, or even weight loss surgery to help lose weight and reduce risk.
The overall guidelines for a healthy lifestyle haven’t changed: The AHA still recommends eating a diet rich in plant-based foods and lean protein, limiting salt, and exercising regularly. However, there have been some small adjustments. There is a new emphasis on reducing sugar and processed food intake, but the new guidelines also note that the occasional indulgence is okay. The idea is to maintain a healthy diet the majority of the time.
In addition, the new guidelines also note that 40 minutes of moderate to vigorous exercise three to four times a week is all that is needed to maintain healthy blood pressure and cholesterol.
Gender and Ethnicity Specific Guidelines
Previous guidelines and risk equations were based primarily on studies involving white men, meaning that the calculations for women and African-Americans were often flawed. The new guidelines provide updated risk equations for multiple populations, meaning that risk can be more accurately measured — and health care providers can offer treatments that are more appropriate.
Disease prevention guidelines change regularly based on new research and treatment options. These new guidelines represent the most up-to-date information, so don’t be surprised if during your next doctor visit, your provider offers new information and suggests different treatment options to help you stay healthy.