Guidelines for Treating Overweight and Obesity.

The recently released “2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults” was created to reflect the latest research to outline best practices when it comes to treating obesity—a condition that affects more than one-third of American adults.

These guidelines help address questions like “What’s the best way to lose weight?” and “When is bariatric surgery appropriate?”.

Here is what every patient should know about the treatment of overweight and obesity:

Definition of obesity:

Obesity is a medical condition in which excess body fat has accumulated to the extent that it can have an adverse effect on one’s health. Obesity can be diagnosed using body mass index (BMI), a measurement of height and weight, as well as waist circumference. Obesity is categorized as having a BMI of 30 or greater. Abdominal obesity is defined as having a waist circumference greater than 40 inches for a man or 35 inches for a woman.

Benefits of weight loss:

Obesity increases risk for serious conditions such as heart disease, diabetes and death, but losing just a little bit of weight can result in significant health benefits. For an adult who is obese, losing just 3–5% of body weight can improve blood pressure and cholesterol levels and reduce risk for heart disease and diabetes. Ideally, doctors recommend 5–10% weight loss for obese adults, which can produce even greater health benefits.

Weight loss strategies:

There is no single diet or weight loss program that works best for all patients. In general, reduced caloric intake and a comprehensive lifestyle intervention involving physical activity and behavior modification tailored according to a patient’s preferences and health status is most successful for sustained weight loss. Further, weight loss interventions should include frequent visits with health care providers and last more than one year for sustained weight loss.

Bariatric Surgery:

Bariatric surgery may be a good option for severely obese patients to reduce their risk of health complications and improve overall health. However, bariatric surgery should be reserved for only the highest risk patients until more evidence is available on this issue. Present guidelines advise that weight loss surgery is only recommended for patients with extreme obesity (BMI>40) or in patients that have a BMI>35, in addition to a chronic health condition.

 

via Guidelines for Treating Overweight and Obesity.

New Cholesterol Guidelines Abandon LDL Targets!

 

The American College of Cardiology (ACC) and American Heart Association (AHA), in conjunction with the National Heart, Lung, and Blood Institute (NHLBI), have developed and released Guidelines for Cholesterol Control after 9 years of the release of the last version. 

And they contain some substantial changes!

Gone are the recommended LDL- and non-HDL–cholesterol targets, specifically those that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL.

According to the expert panel, there is simply no evidence from clinical trials to support treatment to a specific target. As a result, the new guidelines make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of atherosclerotic cardiovascular disease.

Instead, the new guidelines identify four groups of  patients in whom physicians should focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate “intensity” of statin therapy in order to achieve relative reductions in LDL cholesterol.

 

The Four Major Statin Groups

The four major patient groups who should be treated with statins were identified on the basis of randomized, controlled clinical trials showing that the benefit of treatment outweighed the risk of adverse events. The four treatment groups include:

1. Individuals with clinical atherosclerotic cardiovascular disease.

2. Individuals with LDL-cholesterol levels >190 mg/dL, such as those with familial hypercholesterolemia.

3. Individuals with diabetes aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL and without evidence of atherosclerotic cardiovascular disease.

4. Individuals without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease >7.5%.

 

In those with atherosclerotic cardiovascular disease, high-intensity statin therapy—such as rosuvastatin (Crestor, AstraZeneca) 20 to 40 mg or atorvastatin 80 mg—should be used to achieve at least a 50% reduction in LDL cholesterol unless otherwise contraindicated or when statin-associated adverse events are present. In other settings a  moderate reduction of LDL-cholesterol may be aimed for.

The guidelines advise not to aim to achieve a target value of LDL-cholesterol in these patients subsets but advice to start statins in moderate or high intensity to achieve significant reductions in LDL cholesterol from their baseline levels.

 

via New Cholesterol Guidelines Abandon LDL Targets.

Angioplasty has No Benefit Over Medical Therapy in Ischemic Stable CAD

 

A new analysis is calling into question the rationale for many of the angioplasty procedures taking place today in patients with stable coronary artery disease (CAD). In a meta-analysis of more than 5000 patients, Angioplasty was no better than medical therapy in patients with documented ischemia.

Its routine in cardiology practice to advise angioplasty or revascularization if stress test is positive. Patients with ischemia have a worse prognosis than patients who don’t. Thus cardiology practice is focused on finding and treating ischemia. However, the analysis of this study suggests that this approach may not be the right one.

 

Brown and colleagues reviewed the literature for clinical trials of angioplasty and medical therapy for stable CAD conducted over the past 40 years, ultimately including five trials of 5286 patients. These were a small German trial published in 2004, plus MASS II , COURAGE , BARI 2D , and FAME 2 . In all, 4064 patients had myocardial ischemia documented by exercise, nuclear or echo stress imaging, or FFR.

Over a median follow-up of five years, mortality, nonfatal MI, unplanned revascularization, and angina were no different between patients treated medically vs those treated with Angioplasty.

The analysis suggests that it may be worthwhile to continue medical therapy in patients with minimal symptoms and not subject them to unnecessary intervention.

 

via PCI No Benefit Over Medical Therapy in Ischemic Stable CAD.