Advice for a Healthy Heart
drugs are the growing popularity in cholesterol-lowering substances
which many healthy people take to prevent heart disease. Among
the most widely prescribed drugs in the world, statins will
surely be even more popular now that an important government-sponsored
panel of heart disease experts has announced aggressive new
recommendations for treating high blood cholesterol. If everyone
followed the guidelines, it's estimated that 65 million Americans
would change their diet and make other life-style changes, up
from 50 million under the old guidelines, and as many as 36
million would take cholesterol-lowering drugs, compared to the
current 13 million. Recent studies show that such preventive
treatment could substantially cut the number of deaths from
heart disease, the No.1 killer in this country.
the new guidelines, many more Americans are considered to be
at high risk for a heart attack than before, and are thus candidates
for cholesterol-lowering life-style changes and possibly drug
therapy. Now more than ever, you really
need to work with your doctor to evaluate your level of risk.
Even if you have previously had your blood cholesterol measured
and discussed your heart health with your doctor, the new guidelines
mean that you'll need re-evaluation.
are some of the main changes in testing and treatment that may
First, everyone age 20 or older should have a complete blood
cholesterol test, called a "lipid panel" or "lipoprotein
profile," which, unlike the simpler screening test, requires
a 12-hour fast. This measures total cholesterol, as well as
LDL ("bad") and HDL ("good") cholesterol
and triglycerides (fats in the blood). You also need to know
your blood pressure.
While the guidelines for total cholesterol haven't changed
(below 200 is "desirable," 240 and above is "high"),
those for LDL and HDL have. Desirable LDL levels (now called
"optimal" or "near optimal") are still
less than 130, unless you're at high risk for a heart attack
(see below), in which case the new goal is a very low 100.
In the past only those who already had heart disease needed
to aim for this stringent target. For most people, this requires
medication. The minimum for HDL has been raised to 40, up
from 35. HDL below 40 is considered a coronary risk factor.
The risk factors for heart disease are mostly the same, notably
age, smoking, high total and/or LDL cholesterol, low HDL,
high blood pressure, family history of premature heart disease,
and obesity. These factors are even more important now in
determining how aggressively your elevated cholesterol will
Diabetes is now singled out as so potent a risk factor for
heart disease that by itself it puts you in the highest-risk
category, along with people who already have heart disease.
So everyone aged 45 and over should be tested for diabetes.
And people with diabetes now need to get their LDL below 100,
which usually requires drug therapy.
One new risk factor is called "metabolic syndrome,"
which is largely related to obesity and inactivity. You qualify
if you have three or more of the following: abdominal obesity
(a waist more than 40 inches for a man, 35 for a woman); low
HDL (below 40 for a man, 50 for a woman); fasting triglycerides
of 150 or more; elevated blood pressure; and fasting glucose
of 110 or more.
guidelines include a "risk calculator," based on research
from the famous Framingham Heart Study. It uses your age, cholesterol
levels, smoking status, and blood pressure to come up with your
risk for having a heart attack during the next decade. The
calculator does not, by itself, provide the whole picture, however,
and the results can be confusing. You should do this risk assessment
test with your doctor. The results, along with your LDL
level and other risk factors, will help your doctor determine
how much you need to lower your LDL through life-style changes
and perhaps cholesterol-lowering drugs.
if you want to try this formula yourself, it's easiest to use
website, which also provides lots of helpful information
about coronary artery disease. You can also get a free copy
by writing to the NHLBI Information Center, P.O. Box 30105,
Bethesda MD 20824-0105, or call 301-592-8573; ask for "High
Blood CholesterolWhat You Need to Know."
the good life
guidelines also stress the importance of life-style changes,
even for those taking medication.
These steps include exercising, losing weight (via calorie reduction),
stopping smoking, and especially adopting a cholesterol-lowering
diet. For people with elevated blood cholesterol and risk factors,
the dietary goals are stringent: lower saturated fat (less than
7% of total calories, instead of 10% on the usual heart-healthy
diet) and lower dietary cholesterol (less than 200 milligrams
a day, down from 300). But they do allow for more monounsaturated
fat (up to 20% of total calories, instead of 10 to 15%, especially
for those with diabetes or the "metabolic syndrome"
described above). There's also new emphasis on consuming lots
of cholesterol-lowering soluble fiber, like that found in oats
and beans, along with plant compounds called stanols or sterols,
found in some specialty margarines, such as Benecol.
people, and many doctors, are going to focus on the drug advice
in the new guidelines, rather than the life-style advice. That
would be a mistake. Statin drugs are expensive$1,000 to
$1,800 a yearand presumably you'll have to take medication
for life. While they seem to be safe and work well (and may
have other benefits, too), statins can cause minor side effects,
such as gastrointestinal upset, sleep problems, and rashes.
More rarely, statins can cause severe muscle and liver damage,
so you need periodic blood tests for liver function. In addition,
no one knows how safe they are when taken for many years or
new recommendations make it all the more important that you
talk to your doctor about heart disease. They also make it more
likely that doctors will quickly put more patients on statins
(or other cholesterol-lowering drugs). That will save lives,
but having tens of millions of Americans on cholesterol-lowering
drugs is a far-from-perfect solution. Most people don't give
life-style changes a real chance, and their doctors don't help
them enough in their efforts. Take medication if you need it,
but make sure you really need it first. Losing weight, becoming
more active, improving your diet (especially by eating more
fruits, vegetables, and whole grains), and stopping smoking
will help keep you healthy in many ways besides lowering your
cholesterol. These steps, for instance, will also help prevent
diabetes and "metabolic syndrome," two of the big
risk factors for heart disease.
Reference Source 98,99,101