The new guidelines are a joint effort of the American Heart Association, the American College of Cardiology, and the National Heart, Lung, and Blood Institute to revamp guidelines on how to reduce heart disease and stroke risk. Though most of the press coverage has been about cholesterol guidelines it is important to emphasize that half the report was devoted to lifestyle modifications and the importance of us collectively and individually getting our weight down. The reports well document that our collective lack of physical activity, the kinds of foods we are eating, and the quantity of foods we are eating is greatly contributing to the epidemic of diabetes and vascular disease we are seeing as evidenced by heart attacks, sudden death, and stroke.
The reports solidify the safety and role of statins in reducing cardiovascular disease. The statin class of medications have been with us now for four decades and this report widens the audience of people who should consider them.
When patients have asked me over the years about the safety of statins I have half jokingly suggested that they should be in the drinking water. Though we are not yet to the point where anyone is advocating putting these medications in the drinking water – in some parts of the world there has been serious talk of giving everyone a “poly pill” of statin, aspirin, and blood pressure lowering medicine with the expectation that cardiovascular disease would dramatically drop.
In regards to cholesterol the report recommends that everyone with known heart disease and everyone with diabetes be on a statin, regardless of their cholesterol numbers. Furthermore, every one with an LDL “lousy” cholesterol of 190 or more be on a statin, and everyone at increased risk for heart disease consider being on a statin. How do you know if you are at increased risk? One way is to use the excel spread sheet calculator they have created and vetted http://static.heart.org/ahamah/risk/Omnibus_Risk_Estimator.xls
If your risk of having a heart attack, dropping dead, or having a stroke is greater than 7.5% over the next ten years it is recommended that you too be on a statin.
The panels of experts who wrote the reports tired to review and critique the world’s vast literature on these issues and to consolidate and come up with sensible recommendations. Their effort is admirable. It is by no means the last word and will be updated regularly. In future posts I will be exploring some of issues and controversies discussed in the reports including more about lifestyle and weight loss measures, concerns about statins causing diabetes, what to do about people who are intolerant of statins, management of elevated triglycerides, the role of heredity in heart disease, and how newer modalities such as the VAP profile may fit in.
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