The new cardiovascular risk reduction guidelines, or cholesterol treatment guidelines, are crucial for doctors and patients nationwide. They provide a standard of care in determining cardiovascular risk and creating individualized treatment plans. Interestingly, these guidelines now include specific lifestyle recommendations, making them essential for anyone aiming to lead a healthier life.
New Cholesterol Guidelines At A Glance
Cardiovascular disease remains the leading cause of death in America, which is why these guidelines are so important. Four in-depth reports make up the new guidelines. These reports were published online by the American College of Cardiology-American Heart Association (ACC-AHA) Task Force on Practice Guidelines. Each report is a result of the task force’s review of scientific evidence from clinical studies on the relevant topics.
Guideline Details
The guidelines serve as a roadmap for doctors treating patients. First, physicians need to plug the patient’s personal risk variables into the new “risk calculator” (available to all). Variables include sex, age, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure medication, diabetes, and smoking. The calculator provides a ten-year estimated risk for developing cardiovascular disease.
Next, the physician uses the estimated risk to determine if you should be taking a statin drug, known for lowering 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.
Higher risk for heart disease merits high-intensity statin drug therapy, designed to lower LDL cholesterol levels by at least 50%. A higher risk for heart disease is defined as having atherosclerotic cardiovascular disease, unusually high LDL cholesterol levels (190 mg/dl or above), or diabetes.
It is widely agreed that the new cholesterol guidelines will move treatment towards more statin drug use and de-emphasize other valuable agents for a broader range of people. However, exceptions are made for patients over the age of 75 without comorbidities, those on hemodialysis, or those with heart failure.
Lifestyle Counseling Guidelines To Reduce And Prevent Heart Disease
There’s not much new in this category compared to the 2002 guidelines, except for more detailed diet recommendations and the treatment of obesity as a disease. For example, the guidelines suggest consuming plenty of fruits, vegetables, whole grains, nuts, fish, and lean animal meats while reducing fats, red meat, and extra sugar. If you need to lower your blood pressure, the guidelines suggest a low-sodium diet of 2,400 mg daily at first, then aim for 1,500 mg daily for optimal effect. The average American consumes 3,600 mg of sodium daily.
For individuals who are overweight or obese, the guidelines recommend consuming fewer total calories than your body needs, performing aerobic exercise 30 minutes a day at least four days a week, and changing fat-generating food consumption habits.
Doctors are now being directed to put you on a medically supervised weight-loss plan, which includes weighing in, setting and discussing goals, and tracking food and calorie intake. If unsuccessful, bariatric surgery may be recommended. Whether weight loss is needed or not, moderate to vigorous exercise is recommended for 40 minutes three to four times a week, with brisk walking being an optimal exercise.
My Assessment Of The Guidelines
There are several positive aspects of the guidelines. Physicians being encouraged to teach nutrition and oversee weight loss could help improve patients’ health. However, few doctors are qualified or willing to provide proper coaching and guidance in these areas. Instead, they may determine whether a patient should be on a statin drug but only briefly comment on healthy living, exercise, and smoking cessation at the end of a visit. There is a need for coaches to work with doctors to make this more effective.
It’s good to see the authors of the guidelines looking at scientific data on particular diets, nutrients, and lifestyle interventions. However, they fail to acknowledge the importance of nutrient density (nutrients per calories ratio) in reducing chronic disease and obesity more powerfully than merely decreasing calories.
Statin drugs can lower heart disease risk even in people with normal cholesterol levels. However, the guidelines often exclude natural nutrients, such as D-ribose, alpha-lipoic acid, and vitamin K2 MK7 – all of which reduce cardiovascular risk according to peer-reviewed science.
