New Guidelines May Widen Use of Statins
Recommendations focus on patient risk factors rather than cholesterol numbers, experts say
Patients at risk of a heart attack or stroke within the next 10 years should get immediate drug therapy and be encouraged to change their lifestyle, Lloyd-Jones said.
On the other hand, those at lower risk of heart attack or stroke should be counseled to make lifestyle changes and probably do not need drug therapy, he said.
Reducing obesity also cuts heart-health risks, and the new guidelines may help doctors and their plus-sized patients devise an effective -- and perhaps lifesaving -- weight-loss plan.
What works best are lifestyle changes, not crash diets, the authors of the new guidelines said.
"Our recommendation is that doctors prescribe a diet to achieve reduced caloric intake as part of a comprehensive lifestyle intervention," guideline co-author Dr. Donna Ryan, a professor emeritus at Louisiana State University's Pennington Biomedical Research Center in Baton Rouge, said during the press conference. The diet should be tailored to patient preferences and any drugs they take, she said.
Diet, physical activity and face-to-face behavioral counseling combined can lead to "clinically meaningful health improvement," Ryan said. "These benefits begin with weight loss in the range of 3 percent to 5 percent." The most effective behavior programs include two to three meetings a month for six months or more, according to the report.
Nearly 155 million American adults are overweight or obese, which puts them at risk of heart attack, stroke, diabetes and early death. Weight loss will lower blood pressure, improve blood cholesterol levels and reduce the need for medication to manage heart health, Ryan said.
For Americans, heart disease is the leading cause of death.
The experts said doctors should use a patient's body-mass index (BMI) to assess whether a patient is obese or not. BMI is a measure of body fat based on height and weight; a BMI of 25 or more is overweight.
"BMI is a quick and easy first screening step," Ryan said. Calculating BMI at least once a year will help identify those at a higher risk of heart disease and stroke because of their weight, she added. Waist circumference is also an indicator of risk.
Weight-loss surgery, also called bariatric surgery, may be the right option for those who are severely obese (a BMI of 35 or higher), especially if they have two other cardiovascular risk factors, such as diabetes and high blood pressure.
This emphasis on obesity is critical, said Medina, who was not involved with the report.
The problem? "Most patients don't think they are overweight or obese even with a BMI above 40," he said.
Besides reducing obesity, the new guidelines emphasize the need to maintain safe cholesterol levels, eat a healthful diet and assess other risk factors for heart attack and stroke.