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The ACC and American Heart Association Guideline for the Management of Overweight and Obese Adults addresses the appropriateness of the current BMI and waist circumference cut points used to determine risk in overweight and obese adults across diverse populations; the impact of weight loss on risk factors for CVD and type 2 diabetes; optimal behavioral and dietary intervention strategies; lifestyle treatment approaches, such as community-based programs, for weight loss and weight loss maintenance; and benefits and risks of various bariatric surgical procedures.
The new ACC/ American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults focuses on the use of statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in higher risk patients. Here are 5 key points you should know about the recommendations.
American College of Cardiology (ACC)/American Heart Association (AHA) released new Guidelines on the Treatment of Blood Cholesterol last week.
The biggest change in the new guidelines is : “there is no target level of cholesterol to be achieved by the drugs.” Lower levels of cholesterol are better but no particular level is found to be protective. So, the following are no longer considered appropriate strategies: treat to target, lower is best, treat to level of cardiovascular disease risk, and based upon lifetime risk of cardiovascular disease.
Through a rigorous process, four groups of individuals were identified, who would benefit the most with anti-cholesterol drugs called Statins.
Four Statin Benefit Groups:
• 1) Individuals with clinical atherosclerotic disease: coronary artery disease, stroke, or any vascular disease.
• 2) Individuals with elevations of low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dl.
• 3) Individuals 40-75 years of age with diabetes, and LDL-C > 70 mg/dl.
• 4) Individuals who have an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5% or higher.
Individuals in the fourth group can be identified by using the new Pooled Cohort Equations for ASCVD risk prediction, developed by the Risk Assessment Work Group. The 10 year- Cardiovascular Risk Calculator can be calculated by entering your values in the calculator which can be downloaded from the below mentioned site.
The dose of statin advised is either high or moderate in order to reduce LDL cholesterol level by > 50% and 30-50% respectively
Lifestyle modification (i.e., adhering to a heart healthy diet, regular exercise habits, avoidance of tobacco products, and maintenance of a healthy weight) remains a critical component of health promotion and ASCVD risk reduction, both prior to and in concert with the use of cholesterol-lowering drug therapies.
CardioSource – 2013 ACC AHA Guideline on the Treatment of Blood Cholesterol.
“Death in old age is, of course, inevitable, but death in middle age is not”, so rightly said by Dr. Kerr.
Professor Peter Elwood, who is at the School of Public Health at the University of Wales in Cardiff, has done a remarkable piece of work observing a large cohort of Welsh men for over 30 years. By carefully monitoring patterns of behavior — smoking, alcohol consumption, and so on — he has mapped these behaviors onto the risk of developing cardiovascular disease, diabetes, dementia, and, of course, cancer. He showed that if we live well, if we choose to live well, then we can have remarkable reductions in the risk of developing all those types of diseases.
The 5 Longevity “Virtues”
There are 5 basic types of good behavior: regular exercise, not smoking, alcohol consumption within guidelines, maintaining a low BMI (body mass index), and eating a predominantly plant-based diet.
Thus, if one practices 4 or 5 of those “virtues,” compared with men who practice none, the reduction in the risk for cardiovascular disease is around 67%; the reduction in the incidence of diabetes is 73%; the reduction in developing cancer is 20%-25%; remarkably, the reduction in dementia is 65%; and the reduction in all-cause mortality is 32%. Most of the reduction in cancer risk was related to smoking, and frankly the other forms of behavior in this cohort did not affect the development of cancer very remarkably.
Very similar outcomes have been found in large studies in the United States and elsewhere in Western Europe.
Many deaths in middle age are preventable. Let us live well. and Live Long!
Middle-aged women following a healthy Mediterranean-type diet — with an emphasis on fruits, vegetables, whole grains and fish, moderate amounts of alcohol, and little red meat — have much greater odds of healthy aging later on, a new study reports.
“In this study, women with healthier dietary patterns at midlife were 40% more likely to survive to age 70 or over free of major chronic diseases and with no impairment in physical function, cognition or mental health,” said lead study author, Cécilia Samieri, PhD, Institut pour la Santé Publique et le Developpement, Université Bordeaux, France.
This new study adds to growing research on the health benefits of the Mediterranean diet recently reported. Various studies have shown that this diet may contribute to reduced fasting glucose concentrations and lipid levels in those at risk for diabetes, may lower the risk for cardiovascular events and stroke, and improve cognition.
The new study was published in the November 5 issue of Annals of Internal Medicine.
The analysis included 10,670 participants in the Nurses’ Health Study, which began in 1976 when female nurses aged 30 to 55 years completed a mail-in survey. Since then, study participants have been closely followed on a regular basis.
In 1980, participants completed a food-frequency questionnaire (FFQ) that asked how often on average they consumed standard portions of various foods. This questionnaire was repeated in 1984 and 1986 and then every 4 years.
To assess dietary quality at midlife, researchers averaged information from the 1984 and 1986 FFQs. They calculated scores on 2 diet indexes.
In 1992, 1996, and 2000, participants completed the Medical Outcomes Short-Form 36 Health Survey, a questionnaire that evaluates 8 health concepts, including mental health and physical functioning. Scores from the Telephone Interview for Cognitive Status, an adaptation of the Mini-Mental State Examination, were used to evaluate cognitive health. From 1995 to 2001, a cognitive study was administered to participants aged 70 years or older.
Investigators separated “healthy” from “usual” aging on the basis of 4 health domains.
Overall, 11.0% of the participants were considered healthy (and so were free of chronic diseases, such as cancers, myocardial infarction, and diabetes, and with no limitation in cognitive function, mental health, and physical function), and the remaining participants were considered usual agers.
Several health domains were typically impaired among the “usual” agers, said Dr. Samieri. “For example, 33% had both chronic diseases and limitations in cognitive, physical, or mental health; 64% had only limitations in cognitive, physical, or mental health; and 3.4% had only 1 or more chronic diseases.”
The analysis revealed that greater adherence at midlife to the mediterranean diet was strongly associated with greater odds of healthy ageing.
Its a worrying finding for patients.
A significant percentage of patients with coronary artery disease (CAD) still aren’t being prescribed the recommended secondary prevention drugs that could save their lives, a new analysis confirmed.
About a third of CAD patients enrolled in a national registry were not taking a combination of beta-blockers, statins, and ACE inhibitors/angiotensin receptor blockers (ACEI/ARBs) after having a heart attack or undergoing percutaneous coronary intervention (Angioplasty/ PCI) or coronary artery bypass grafting (CABG/ bypass surgery).
And compliance with the secondary prevention drug recommendations varied greatly from practice to practice, researcher Thomas M. Maddox, MD, of the VA Eastern Colorado Health Care System in Denver, and colleagues, wrote online Oct. 30 in the Journal of the American College of Cardiology.
The researchers examined data from the American College of Cardiology’s PINNACLE Registry, which is the first national, prospective, outpatient-based cardiac quality improvement registry of patients being treated in cardiology practices in the U.S.
Patients treated at 58 PINNACLE practices between July of 2008 and December of 2010 were included in the analysis.
Among 156,145 coronary artery disease (CAD) patients treated at 58 participating practices, 66.5% were taking beta-blockers, statins, and ACE inhibitors/angiotensin receptor blockers on their first post-event visit, and only slightly more (69.7%) had been prescribed these recommended medications a year later.
This is worrying that one-third of the patients are not getting the necessary drugs to prolong survival. This is despite the fact that most of the doctors have now access to latest medical information and guidelines due to availability of smart phones and internet access. If this is the situation in the western world, it would be worse in the developing countries.
In an editorial published with the analysis, L. Kristin Newby, MD, of Duke University, wrote that efforts to increase the use of optimal drugs for secondary prevention should focus not only on cardiologists but also family practice physicians, internists, gynecologists, and advanced practice providers such as nurse practitioners and physician’s assistants.