The new guidelines on cholesterol treatment advocate aggressive control of Cholesterol levels by drugs called statins for primary prevention of heart disease. They advocate high-intensity and moderate intensity statins in patients with intermediate risks of developing heart disease.
Majority of the Physicians would be following these recommendations. But, there is a great need to discuss the risks and benefits of statin therapy with individual patients.
These become more relevant when we know that statins do increase marginally the incidence of developing diabetes.
Two recent studies also throw up interesting findings:
Study 1. A study presented in April 2014 at the Society of General Internal Medicine meeting in San Diego showed that individuals prescribed statin therapy for high cholesterol consumed more calories and more fat than nonstatin users. And, not surprisingly, this increase in calories paralleled an increase in BMI in statin users.
Study 2. An analysis of a prospective cohort study of men (published in JAMA Internal Medicine) revealed that physical-activity levels were “modestly” lower among statin users compared with nonusers independent of other cardiac medications and of medical history.
Though there may be a biologic or chemical explanation for the above findings, the above studies point to Lifestyle-Statin interaction whereby there seems to be a sense of protection felt by the patients on statins. Individuals on statins (due to a sense of security due to their drug compliance) may be abandoning on Diet moderation and Physical activity. This abandoning of important lifestyle measures would reduce gains of statin therapy.
The above findings suggest that Physicians need to continuously emphasise the importance of Lifestyle measures to individual patients irrespective of their cholesterol levels or statin therapy!
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 European Society of Cardiology and the European Society of Hypertension released Guidelines for Physicians to treat Hypertension (high BP). The joint guidelines are designed to reduce the morbidity and mortality associated with hypertension.
Worldwide, 1.5 billion people currently have high blood pressure, according to the World Health Organization.
Dr Robert Fagard, the chair of the ESH/ESC writing committee, reiterated that treatment decisions for patients should be dictated by their overall level of risk and a holistic approach to treatment should be advised by physicians.
Lifestyle changes for treatment!.
The new guidelines make a host of lifestyle recommendations for lowering blood pressure.
1. Salt intake: The Guidelines recommend salt intake of approximately 5 to 6 g per day, in contrast with a typical intake of 9 to 12 g per day. A reduction to 5 g per day can decrease systolic blood pressure about 1 to 2 mm Hg in normotensive individuals and 4 to 5 mm Hg in hypertensive patients.
2. Lower BMI: While the optimal body-mass index (BMI) is not known, the guidelines recommend getting BMIs down to 25 kg/m2 and reducing waist circumferences to <102 cm in men and <88 cm in women. Losing about 5 kg can reduce systolic blood pressure by as much as 4 mm Hg.
3. Exercise: Aerobic endurance training in hypertensive patients can reduce systolic blood pressure by 7 mm Hg.
Fagard said that physicians can typically give low/moderate-risk individuals a few months with lifestyle changes to determine whether they’re having an impact on blood pressure. They should be more aggressive with higher-risk patients, however, noting that drug therapy is started typically within a few weeks if diet and exercise are ineffective.
via ESH/ESC publish hypertension guidelines | theheart.org.