The American Heart Association and American College of Cardiology have issued the first new guidelines in a decade for preventing heart attacks and strokes. Among other things, they call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.
The guidelines take aim at strokes, not just heart attacks. They're personalized for men and women, and blacks and whites. They estimate a person's risk in a novel way and change the goal of treating high cholesterol.
A new formula includes age, sex, race, blood pressure, cholesterol, diabetes and smoking. People ages 40 to 79 should get an estimate every four to six years. If risk is still unclear, family history or three other tests can be considered. The best one is a coronary artery calcium test, an X-ray to measure calcium in heart arteries.
High cholesterol leads to hardened arteries, which can cause a heart attack or stroke. Most cholesterol is made by the liver, so diet changes have a limited effect, and many people need medicines to lower their risk.
The guidelines don't change the definition of high cholesterol, but they say doctors should no longer aim for a specific number with whatever drugs can get a patient there. The new advice stresses statins such as Lipitor and Zocor; most are generic and cost as little as a dime a day.
WHO NEEDS TREATMENT?
Four groups are targeted:
—People who already have heart disease (clogged arteries).
—Those whose LDL, or "bad cholesterol," is 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 attack or stroke of 7.5 percent or higher, based on the new formula. (This means that for every 100 people with a similar risk profile, seven to eight would have a heart attack or a stroke within 10 years.)
THE BOTTOM LINE
About one-third of U.S. adults — 44 percent of men and 22 percent of women — would have enough risk to consider a statin. Only 15 percent of adults do now.
THE ROLE OF LIFESTYLE
Guidelines also recommend 40 minutes of moderate to vigorous exercise three to four times a week. They call for a "dietary pattern" that is focused on vegetables, fruits and whole grains and includes low-fat dairy products, poultry, fish, beans and healthy oils and nuts. Limit sweets, sweet drinks, red meat, saturated fat and salt.
To fight obesity, doctors should develop individualized weight-loss plans including a moderately reduced-calorie diet, exercise and behavior strategies. The best plans offer two to three in-person meetings a month for at least six months. Web or phone-based programs are a less-ideal option.