Integrative Way

New guidelines recommend statins for 30 million Americans

 

The Sacramento Bee

Breaking news: One quarter of Americans reading this article should be on a cholesterol-lowering statin medicine per new guidelines put out last month by the American Heart Association and the American College of Cardiology.

You are one of them if you have:

• Known cardiovascular disease, old heart attack, stroke or symptoms that indicate clogged arteries (chest pain, leg pain);

• Age 20 to 75 with LDL (low-density lipoprotein) cholesterol above 190;

• Type 1 or 2 diabetes between the ages of 40 to 75;

• And the new recommendation: healthy people with a 7.5 percent 10-year risk of heart disease regardless of cholesterol readings.

The updated recommendations estimate that 30 million Americans fall into the above categories and should consider a statin medication to lower their cholesterol.

So should you run out to your doctor to get a prescription? Perhaps, but the new recommendations have their flaws:

• Critics question the use of a 10-year risk of heart attack or stroke as the measure for determining who should be treated. (Why not a lifetime risk or some other metric?)

• It appears that the calculator used may overestimate the risk due to the data it was based on.

• Without the old goals of target numbers of cholesterol for certain heart risk categories, patients and their doctors may lose motivation to control or follow cholesterol levels.

• Old habits are hard to change, and it may be years before cardiologists and primary care doctors are comfortable throwing away prior LDL guidelines for high-risk patients.

• The new guidelines could easily lead to overtreatment.

Overlooked by most recent media reports, and perhaps most important for those who wish to pursue a proactive, holistic lifestyle: The recommendations state that just because the new risk calculator suggests some people would benefit from statins doesn’t mean they absolutely have to take them.

Instead, it is intended that the risk calculator should prompt a conversation between doctor and patient about whether there is a need to take statins or undertake other lifestyle changes to lower cholesterol.

Case in point: A 60-year-old African American woman who smokes and has high blood pressure with a low LDL level is recommended to qualify for a statin under the new guidelines, as she is calculated at a 16 percent 10-year risk for developing heart disease.

However, practical wisdom suggests that perhaps she should stop smoking and control her blood pressure first.

It is important to note that the new statin guidelines are only one part of a package of recommendations to reduce the risk of heart attack and stroke that includes moderate exercise and a healthy diet.

In a much less publicized companion article in the Journal Circulation, simultaneous recommendations were made for diet and exercise in patients with high risk of coronary artery disease.

For patients with high cholesterol, there is strong research that shows efficacy in changing diet in reducing cholesterol levels. The recommendation is to eat fruits, vegetables, whole grains, low-fat dairy, poultry, fish, legumes, non-tropical vegetable oils and nuts and limit intake of sweets, sugar-sweetened beverages and red meats.

The exercise prescription recommended for high cholesterol includes aerobic physical activity three to four times a week lasting an average of 40 minutes a session, plus some moderate to vigorous physical activity.

So what do we recommend ?

Eat right – stop the processed and sugary foods – move your body at least four days a week, stop smoking and lose weight.

You may be able to pull yourself out of the ranks of the Americans who need to be on a statin.

To calculate your personal risk of heart disease based on the new guidelines, go to the American Heart Association’s website at www.heart.org.

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