New Guidelines Issued
on Heart Attack Prevention
Excerpt By Karla Gale, Reuters Health

NEW YORK (Reuters Health) - The American Heart Association (AHA) and the American College of Cardiology (ACC) have issued new guidelines on how doctors can help their patients with heart and blood vessel disease reduce their risk of heart attack and stroke.

The guidelines urge wider use of beta-blockers and ACE inhibitors, state that hormone replacement therapy has no heart-health benefit for women with existing heart disease, and stress the importance of exercise.

The ACC and AHA issued their last consensus statement in 1995. Since then, new findings have shown that beta-blockers should be given to all heart disease patients, not just those who have suffered a heart attack, Dr. Noel Bairey Merz, chair of the ACC's prevention committee, told Reuters Health.

Similarly, ACE inhibitors should now be given to patients with the build-up of fatty material in their arteries known as atherosclerosis, and not limited to patients with high blood pressure and congestive heart failure, she said.

The AHA/ACC have also revised their guidelines regarding hormone replacement therapy in women with heart disease, because several trials have demonstrated no benefit.

``We also place much more emphasis on exercise,'' said Bairey Merz, who is director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center in Los Angeles. ''It's the physician's job to really push for daily physical activity in these patients.''

In its statement, the consensus panel notes that many patients for whom therapies are indicated go untreated. Bairey Merz pointed out that fewer than half of appropriate patients are being treated with drugs to lower levels of fat in the blood, known as lipid-lowering agents. The use of beta-blockers is not much better.

``We really are arming and challenging physicians to rise to this evidence,'' she said. ``They need to call their patients back in, re-evaluate them, and get them on the right drugs.''

While cost can be an issue, Bairey Merz noted that many beta-blockers are available in generic versions, and that a lipid-lowering agent was recently approved for generic status. ''So we are starting to get into monthly costs that are like having a Starbucks coffee every day,'' she pointed out.

Besides, she asked, ``Do you want to spend money on ambulances, intensive care units and bypass surgery, or do you want to spend your money on prevention? Ten years of a cholesterol-lowering drug is still less expensive than bypass surgery, so all you have to do is avoid a few in 100 patients and you're paying for the drug.''

Reference Source 89

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