The new cardiovascular risk reduction guidelines (aka cholesterol treatment guidelines) are extremely important to physicians and their patients nationwide. Why? These new guidelines will now be the standard of care to determine cardiovascular risk and to formulate an individual treatment plan.
Critics of the guidelines claim they do little more than just determine who should take a statin and who should not. The new guidelines are particularly interesting to me because for the first time they actually include specific lifestyle recommendations. I’ll cover the important components of the guidelines in this article and share with you the other natural nutrient treatment options (that the guidelines don’t include) in my next article New Truths About Cholesterol
New Cholesterol Guidelines At A Glance
First off, you can understand why there is such a huge focus on reducing cardiovascular disease. After all, this continues to be the leading cause of death in America.
On Nov. 12, four in-depth official reports were published online by a large and qualified task force of physicians and educators, named the American College of Cardiology–American Heart Association (ACC-AHA) Task Force on Practice Guidelines.
These are the reports: a “Guideline on Lifestyle Management to Reduce Cardiovascular Risk” [1] ; a “Guideline for the management of Overweight and Obesity in Adults” [2] ; a “Guideline on the Treatment of Blood Cholesterol” [3] ; and a “Guideline on the Assessment of Cardiovascular Risk.” [4] These guidelines were the result of reviews by the task force of the scientific evidence from large clinical studies on these topics. As you can guess, they omit important natural health principles and nutrient supplements proven to lower cardiovascular risk. The guideline resource page of the American Heart Association ishere.
Guideline Details
Here is how a physician uses the guidelines like a road map for patients: First, a physician should plug in the patient’s personal risk variables into the new “risk calculator” (in Excel format, available to all).
The risk variables for the risk calculator include: sex, age, race (white or African-American), total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure medication (Y/N), diabetes (Y/N), and smoking (Y/N). The calculator gives an estimated 10-year predicted risk for developing new cardiovascular disease. I did it for me and I was pleased to find my risk currently is 2.8 percent.
Next, the physician uses your predicted risk to determine if you should be taking a statin drug (proven to lower cardiovascular risk and blood cholesterol). According to these guidelines, anyone with even a small risk for heart disease should be taking at least a low-dose statin drug. A small risk for heart disease (that mandates a statin) is defined as one of the following:
- Diabetes (type 1 or 2) age 40-75 with moderately elevated LDL cholesterol (70 to 189 mg/dl) and a 10-year predicted risk for developing new heart disease of less than 7.5 percent.
- No diabetes, age 40-75, an LDL cholesterol level of 70 to 189 mg/dl and a 10-year predicted risk for developing new heart disease of greater than 7.5 percent.
A higher risk for heart disease merits high-intensity statin drug therapy (aimed at lowering LDL cholesterol levels by ≥50 percent) according to the new guidelines. A higher risk for heart disease is defined as one of the following:
- The presence of atherosclerotic cardiovascular disease.
- Low-density lipoprotein (LDL) cholesterol levels super high at 190 mg/dl or above.
- Diabetes (type 1 or 2) with moderately high LDL cholesterol (70 to 189 mg/dl) and a 10-year predicted risk for developing new atherosclerotic cardiovascular disease of greater than 7.5 percent.
Statin Increase
Medical reviewers of these guidelines agree that, overall, these cholesterol guidelines will move treatment toward more statin drug use and de-emphasize other valuable agents for a broader range of people than the previous recommendations. [5] These widened inclusion criteria for statin use, however, do have a few exceptions: those over age 75 without proven heart disease; those on hemodialysis; or class II, III or IV heart failure patients.
Finally, the guidelines indication that a physician should counsel you as needed in the lifestyle and other areas including diet, exercise, weight loss, smoking cessation, blood pressure control, blood sugar control and cholesterol level control. That is the subject of two of the four reports.
I’ll summarize how the guidelines suggest you should be counseled.
Lifestyle Counseling Guidelines To Reduce And Prevent Heart Disease
There’s actually not much new in this category compared to the 2002 guidelines except that more detail is provided in diet recommendations. In addition, obesity is now being treated as a disease. For example, the guidelines recommend consuming plenty of fruits, vegetables, whole grains, nuts, fish and lean animal meats. You should reduce fats, red meat and extra sugar. Don’t worry about occasional indulgences if your overall pattern is a healthy one. If you need to lower your blood pressure, then you should aim for a low-sodium diet of 2,400 mg daily at first, then aim for 1,500 mg daily for optimal effect on blood pressure. The average American consumes 3,600 mg of sodium daily.
Remember that ¼ teaspoon table salt is 1,200 mg of sodium. Remember also to read the nutrition facts label of packaged or canned foods you consume and count the sodium content listed there.
The guidelines cover three aspects of being overweight and obese:
- Eat less food (total calories) than your body needs.
- Perform aerobic exercise for 30 minutes at least four days a week.
- Change your fat-generating food-consumption habits.
Your doctor now has the directive to put you on a medically supervised weight-loss plan (insurance must cover these visits to the doctor for this) where you weigh in, set and discuss goals, track your food and calorie intake, and get motivated to control bad food eating habits. If not successful, you may be urged to have bariatric surgery. Whether weight loss is needed or not, moderate to vigorous exercise is recommended for 40 minutes three to four times weekly. (Brisk walking is considered an optimal exercise.)
My Assessment Of The Guidelines
There are several things I like about the guidelines. I like the way physicians are strongly urged to teach nutrition and to oversee weight loss. But my honest opinion is that few physicians are qualified or will take the time to really coach their patients in these areas. Instead, they will determine if a patient should be on a statin drug and then just comment on the need to eat healthy, exercise and quit smoking at the end of the visit. I imagine there will be a need for coaches to work with doctors to make this really effective. [6]
I like that the authors of the guidelines looked at scientific data regarding particular types of diets, nutrients and lifestyle interventions to include in their reports.
However, I have learned that it is the nutrient density (nutrients per calories ratio) that reduces chronic disease and obesity much more powerfully than just reducing calories.
To illustrate, there are only 200 calories in a glazed Krispy Kreme donut. Therefore, eating five donuts daily add up to 1,000 calories, but those donuts do not provide any meaningful micronutrient value.
In fact, those donuts promote many chronic diseases due to their refined sugar and fat.
On the other hand, can you imagine the health-promoting effects of 1,000 calories from a huge mixed-green salad that includes onions, peppers, olives, mushrooms, tomatoes, boiled eggs, feta cheese, artichoke hearts and avocado chunks and is topped with chicken or salmon, croutons and your favorite low-sugar dressing? This is loaded with fiber, healthy oil and plenty of other micronutrients.
I like the ease of use of the risk calculator. It’s highly motivating to see a 10-year predicted risk as a percentage. What I don’t like is that the risk calculator is used to prescribe a statin drug (or recommend against one).
It’s good that statin drugs lower heart disease risk even in people with normal cholesterol levels — but they have excluded natural nutrients in their guidelines such as D-ribose, alpha lipoic acid, vitamin K2 MK7 and several others, all of which reduce cardiovascular risk according to the peer-reviewed science. I’ll be discussing these in my next article.
To knowing how to stay feeling good for health,
Michael Cutler, M.D.
Easy Health Options
[1] Eckel RH, Jakicic JM, Ard JD, Miller NH, Hubbard VS, Nonas CA, de Jesus JM, Sacks FM, Lee IM, Smith SC Jr, Lichtenstein AH, Svetkey LP, Loria CM, Wadden TW, Millen BE, Yanovski SZ. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Nov 7.
[2] Jensen MD, Ryan DH, Apovian CM, Loria CM, Ard JD, Millen BE, Comuzzie AG, Nonas CA, Donato KA, Pi-Sunyer FX, Hu FB, Stevens J, Hubbard VS, Stevens VJ, Jakicic JM, Wadden TA, Kushner RF, Wolfe BM, Yanovski SZ. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2013 Nov 7.
[3] Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Lloyd-Jones DM, Blum CB, McBride P, Eckel RH, Schwartz JS, Goldberg AC, Shero ST, Gordon D, Smith SC Jr, Levy D, Watson K, Wilson PW. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Nov 7.
[4] Goff DC Jr, Lloyd-Jones DM, Bennett G, O’Donnell CJ, Coady S, Robinson J, D’Agostino RB Sr, Schwartz JS, Gibbons R, Shero ST, Greenland P, Smith SC Jr, Lackland DT, Sorlie P, Levy D, Stone NJ, Wilson PW. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Nov 7.
[5] Keaney JF Jr, Curfman GD, Jarcho JA.A Pragmatic View of the New Cholesterol Treatment Guidelines. N Engl J Med. 2013 Nov 27. Online at: http://www.nejm.org/doi/full/10.1056/NEJMms1314569
[6] See my Oct 1, 2012 Easy Health Options article entitled “Ideas on a health provider coaching model” published online at http://easyhealthoptions.com/alternative-medicine/developing-a-healthcare-provider-coaching-model/
