New guides for preventing heart attacks, strokes

AP:The American Heart Association and American College of Cardiology have issued the first new guidelines in a decade for preventing heart attacks and strokes. Among other things, they call for twice as many Americans, one-third of all adults, to consider taking cholesterol-lowering statin drugs.

What's new

The guidelines take aim at strokes, not just heart attacks. They are personalised for men and women, and blacks and whites. They estimate a person's risk in a novel way and change the goal of treating high cholesterol.

Estimating risk

A new formula includes age, sex, race, blood pressure, cholesterol, diabetes, and smoking. People, ages 40 to 79, should get an estimate every four to six years. If risk is still unclear, family history or three other tests can be considered. The best one is a coronary artery calcium test, an X-ray to measure calcium in heart arteries.

Cholesterol

High cholesterol leads to hardened arteries, which can cause a heart attack or stroke. Most cholesterol is made by the liver, so diet changes have a limited effect, and many people need medicines to lower their risk.

The guidelines don't change the definition of high cholesterol, but they say doctors should no longer aim for a specific number with whatever drugs can get a patient there. The new advice stresses statins such as Lipitor and Zocor; most are generic and cost as little as a dime a day.

The role of lifestyle

Guidelines also recommend 40 minutes of moderate to vigorous exercise three to four times a week. They call for a "dietary pattern" that is focused on vegetables, fruits and whole grains and includes low-fat dairy products, poultry, fish, beans and healthy oils and nuts. Limit sweets, sweet drinks, red meat, saturated fat, and salt.

To fight obesity, doctors should develop individualised weight-loss plans including a moderately reduced-calorie diet, exercise, and behaviour strategies. The best plans offer two to three in-person meetings a month for at least six months. Web or phone-based programs are less ideal options.