On Tuesday, the American Heart Association and American College of Cardiology released the new guidelines to try and prevent heart attacks and strokes. They focus on cholesterol-lowering statin drugs, a new way to assess risk and a healthy lifestyle.
The guidelines offer doctors a new formula for estimating a patient’s risk that includes many factors besides a high cholesterol level, the main focus now. The formula includes age, gender, race and factors such as whether someone smokes. The definition of high cholesterol isn’t changing, but the treatment goal is. Instead of aiming for a specific number, using whatever drugs get a patient there, the advice stresses statins such as Lipitor and Zocor and identifies four groups of people they help the most.
Doctors say the new approach will limit how many people with low heart risks are put on statins simply because of a cholesterol number. Yet under the new advice, 33 million Americans — 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.
Doctors 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.
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.