introduced by the nation's leading heart experts could greatly expand the
number of Americans taking cholesterol-lowering statins.
shift: Doctors are now being told to no longer adhere to rigid clinical
guidelines that trigger the use of a statins when cholesterol levels reach a
will be advised to take a statin if they already have heart disease, if their
bad (LDL) cholesterol is extremely high (190 milligrams per decilitre 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% 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
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
Appropriate level of statin therapy
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.
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 North-western University Feinberg School of
Medicine and chairman of the cholesterol committee, said during a press
cholesterol policy "suggests treatment should be individualised 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 HealthDay.
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 committee added.
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
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 North-western University
Feinberg School of Medicine and co-chairman of the committee, said during the
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 counselled to make
lifestyle changes and probably do not need drug therapy, he said.
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
What works best
are lifestyle changes, not crash diets, the authors of the new guidelines said.
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 Centre in Baton Rouge, said during the press
conference. The diet should be tailored to patient preferences and any drugs
they take, she said.
activity and face-to-face behavioural counselling combined can lead to
"clinically meaningful health improvement," Ryan said. "These
benefits begin with weight loss in the range of 3% to 5%." The most
effective behaviour programmes include two to three meetings a month for six
months or more, according to the report.
Medication to manage heart health
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 overweight.
"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.
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.
"Most patients don't think they are overweight or obese even with a BMI
above 40," he said.
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
Healthy Diet and
A healthy diet not
necessarily a low-calorie diet and exercise reduce the risk for cardiovascular
disease by lowering blood pressure and cholesterol.
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
diet of 2 000 calories per day should include:
Four or five servings of
fruit daily, four or five servings of
vegetables daily, six to eight servings of
whole grains daily, two or three servings of
fat-free or low-fat dairy products daily, six or fewer ounces of
poultry or fish daily, four or five servings of
nuts, legumes and seeds a week, two or three servings of
healthy oils a day, limited sweets and
To reduce high
blood pressure, limit salt intake to 1 500 milligrams a day, the committee
said. US 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 US 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
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, visit the American